How does Insurance in US work??

Usually employers offer health insurance (medical and dental) as a benefit - meaning the employee pays a monthly premium and the employer negotiates a group insurance for all its employees. The insurance plan you choose (most companies offer several options) determines exactly what will be covered and how much you have to pay. Most medically necessary procedures and services are covered. Under the HMO category, you have to go through a primary care physician and they will refer you to specialists in their network, but you have to pay less out of pocket for services.

For the PPO category, you can choose your own specialist and don't have to go through a primary care provider but your out of pocket costs may be higher (I pay 20% and my insurance co pays 80%).

When you said TTC did you mean fertility treatments? I don't know to what extent they are covered. One idea is to ask the hospital to send you the health insurance plan summaries so that you can read through and see what is covered and the terms for each plan.

 

You need to have your husband check with the Human Resources dept at Johns Hopkins to find out if pregnancy at date of hire would be a pre-existing condition. If it is, they will not cover the whole pregnancy which could be devastating should you have problems.

 

Hi Rosenav,

I don't know in detail about how the health insurance system works here in the US either, but I will tell you what I know based on my experience here.

Firstly, some insurance providers will not cover pre-existing illnesses. It means that if you were diagnosed with an illness before you took insurance with that provider, then you will not be covered for treatment of that illness. However, some insurance policies do not include pregnancy as a pre-existing illness. I would also suggest that you find out from your husband's employer what exactly your insurance plan is, and if pregnancy is included in the pre-existing illnesses that are not covered.

I would suggest that you wait until you find out these details and know your insurance plan fully.

Then, like pavarun said, there are two types of plans, one which allows you to see a specialist directly, and another which allows you access to a specialist only through a referal from your primary physician. The basic difference of these two is that you pay more to be able to see a specialist directly, without seeing your primary physician first.

 

Rosenav,

That is a good point that Tashidelek brought up reg. pre-existing condition. Federal law bans pregnancy from being treated as a preexisting condition BUT I believe that is only when moving from one group insurance plan to another. So if you are pregnant by the time you move to US they may treat it as a pre-existing cndition and deny coverage (since your current insurace may not be a group plan here). You can call Blue Cross Blue shield and find out what their policy is.

If you are TTC, my advice is to temporarily suspend until coming here and DH joins his job (just to be safe). If you conceive after the insurance effective date then everything will be fine.

Ask your DH's co-workers to send you a Summary Plan literature for both PPO and PPO enhanced options and read through.

 

Rosenav:
You might want to check the BCBS website and see if the information you need is listed:

Blue Cross Blue Shield Association - Leading the Future of Healthcare