Newly Married, Pregnant and Plan Decisions
Hi everyone, I appreciate the advice as I have called my provider and asked around, but am still having trouble making the best decision. My situation has also changed a lot in the past few weeks. I am recently married and my new wife is also now pregnant. She will be added to my employer health insurance as we are still within the married qualifying life event window and our baby is due in mid July. Coincidentally, my employer yearly cycle goes into effect every July 1st and open enrollment runs at the beginning of June.
There are 4 plans to choose from with the PPO plan having In-Network and Out-of-Network coverages below. The EPO plans do not have any Out-of-Network coverages.
We are both healthy individuals, but I am curious what everyone recommends the best plan for wife and I now given upcoming pregnancy appointments, tests etc.? Our situation is timely with due date and the next open enrollment, assuming the plans do not change drastically any thought on what is best then? I’m thinking a lower OOP for late pregnancy and birthing costs? Thank you for the help!
PPO $0 (In-Network)PPO $0 (Out-of-Network)EPO $750EPO $1,500EPO with HSA $3,000Cost per biweekly paycheck for couple (x26)$102.75Same as Left$68.78$0$0Cost per biweekly paycheck for family (x26)$152.81Same as Left$102.28$0$0Deductible$0$4,000$1,500$3,000$6,000Cross AccumulationNoNoN/AN/AN/AOOP Max$12,700$12,700$5,500$6,000$6,000Office Visits (PCP / SPC)$25/$40 Copay30% after deductible$30/$50 Copay$35 Copay0% after deductibleDiagnostic Testing (x-ray, blood work)Covered in Full30% after deductible20% after deductible20% after deductible0% after deductibleComplex Diagnostic TestingCovered in Full30% after deductible20% after deductible20% after deductible0% after deductibleHospital Services (Inpatient)$500 Copay30% after deductible20% after deductible20% after deductible0% after deductibleHospital Services (Outpatient)$300 Copay30% after deductible20% after deductible20% after deductible0% after deductibleUrgent Care$40 Copay$40 Copay$50 Copay$35 Copay0% after deductibleEmergency Room$200 Copay$200 Copay$150 Copay$150 Copay0% after deductibleRx DeductibleN/ANot CoveredN/A$100/$200 on Tier 2 and Tier 3N/ARetail Prescription Drugs$10 / $30 / $50Not Covered$10 / $50 / $70$10 / $35 / $700% after deductible