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PhyllisNJoe
My Box Is Broken
Member since 6/11 9145 total posts
Name:
Phyllis
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Fidelis metal tier health Insurance?
Anyone have this? We are looking for yet another insurance because the one we have (emblem health with ded, high copays and referrals to breathe) is going up by almost $300 per month. Our insurance guy said a lot of people are going with fidelis because it’s not as expensive and is still good coverage.
He was sure to say it’s not from the Exchange but metal tier version (he’s says there’s a difference )
Anyone have it ? Pros and cons?
Thanks
I cannot and will not pay almost $2,100 per month for what we have now. It is DISGUSTING.
Message edited 9/19/2019 3:43:28 PM.
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Posted 9/19/19 3:43 PM  |
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MrsWoods
LIF Adult
Member since 4/12 1461 total posts
Name:
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Re: Fidelis metal tier health Insurance?
We have Fidelis Platinum Metal Tier which is the highest. We got it on the exchange and that does not include dental or vision. Its was based off our income so for my husband and i its less than $1200 and my daughter has child health plus with Fidelis Care and we pay $60 for that which has dental and vison just for her. I know alot of meds aren't covered or they need prior authorization which is a pain. And some procedures also need prior authorization. We do have lots of good doctors to choose from which is nice and do not need referrals with the platinum tier. So i have no major complaints.
Message edited 9/19/2019 6:33:24 PM.
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| Posted 9/19/19 6:32 PM |
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PhyllisNJoe
My Box Is Broken
Member since 6/11 9145 total posts
Name:
Phyllis
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Re: Fidelis metal tier health Insurance?
Posted by MrsWoods
We have Fidelis Platinum Metal Tier which is the highest. We got it on the exchange and that does not include dental or vision. Its was based off our income so for my husband and i its less than $1200 and my daughter has child health plus with Fidelis Care and we pay $60 for that which has dental and vison just for her. I know alot of meds aren't covered or they need prior authorization which is a pain. And some procedures also need prior authorization. We do have lots of good doctors to choose from which is nice and do not need referrals with the platinum tier. So i have no major complaints.
Thank you. The platinum is what we are looking at. My DH and I can get it for just under $1700 a month which is $100 less then what we pay for Emblem (which I hate with a passion)
Can you explain how certain meds aren’t covered and prior auth for medication? I don’t think I’ve ever heard of that before. I love the idea of no referrals tho. That alone will save me tons of time.
Also, do you mind sharing what your copays are w/platinum plan?
Thanks again!
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| Posted 9/19/19 6:57 PM |
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MrsWoods
LIF Adult
Member since 4/12 1461 total posts
Name:
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Re: Fidelis metal tier health Insurance?
Posted by PhyllisNJoe
Posted by MrsWoods
We have Fidelis Platinum Metal Tier which is the highest. We got it on the exchange and that does not include dental or vision. Its was based off our income so for my husband and i its less than $1200 and my daughter has child health plus with Fidelis Care and we pay $60 for that which has dental and vison just for her. I know alot of meds aren't covered or they need prior authorization which is a pain. And some procedures also need prior authorization. We do have lots of good doctors to choose from which is nice and do not need referrals with the platinum tier. So i have no major complaints.
Thank you. The platinum is what we are looking at. My DH and I can get it for just under $1700 a month which is $100 less then what we pay for Emblem (which I hate with a passion)
Can you explain how certain meds aren’t covered and prior auth for medication? I don’t think I’ve ever heard of that before. I love the idea of no referrals tho. That alone will save me tons of time.
Also, do you mind sharing what your copays are w/platinum plan?
Thanks again!
Copays are $15 primary Doc and Specialist $35. Urgent care $55, ER $100, Inpatient $500
And as far as the drugs go, they have their own formulary, which i will include, so some drugs they do not include in it and some that they do need a prior authorization. So basically the pharmacy notifies the doctor and then they have to send a form for why you need the meds and that can take days or a couple weeks.
2019 formulary
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| Posted 9/19/19 7:28 PM |
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PhyllisNJoe
My Box Is Broken
Member since 6/11 9145 total posts
Name:
Phyllis
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Re: Fidelis metal tier health Insurance?
Posted by MrsWoods
Posted by PhyllisNJoe
Posted by MrsWoods
We have Fidelis Platinum Metal Tier which is the highest. We got it on the exchange and that does not include dental or vision. Its was based off our income so for my husband and i its less than $1200 and my daughter has child health plus with Fidelis Care and we pay $60 for that which has dental and vison just for her. I know alot of meds aren't covered or they need prior authorization which is a pain. And some procedures also need prior authorization. We do have lots of good doctors to choose from which is nice and do not need referrals with the platinum tier. So i have no major complaints.
Thank you. The platinum is what we are looking at. My DH and I can get it for just under $1700 a month which is $100 less then what we pay for Emblem (which I hate with a passion)
Can you explain how certain meds aren’t covered and prior auth for medication? I don’t think I’ve ever heard of that before. I love the idea of no referrals tho. That alone will save me tons of time.
Also, do you mind sharing what your copays are w/platinum plan?
Thanks again!
Copays are $15 primary Doc and Specialist $35. Urgent care $55, ER $100, Inpatient $500
And as far as the drugs go, they have their own formulary, which i will include, so some drugs they do not include in it and some that they do need a prior authorization. So basically the pharmacy notifies the doctor and then they have to send a form for why you need the meds and that can take days or a couple weeks.
2019 formulary
Thank you. I really appreciate the info. Meds I’m on now and have been on in the past are on here. And those copays are magical to me. I pay double that now.
Thanks again!
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| Posted 9/19/19 8:53 PM |
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hmm
Sweet
Member since 1/14 7993 total posts
Name:
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Fidelis metal tier health Insurance?
you can go online / google and see the list of drugs and tiers
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| Posted 9/19/19 10:47 PM |
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