We’re in the midst of transitioning to a different health insurance plan due to changing employers, so I wanted to take this time to write a review of Lumenos CDHP, which I’ve been using for the past two years or so and have been very happy with. I don’t know if it’s because it’s relatively new or because it’s not yet offered by many employers that there seems to be little information about this particular health insurance provider.
Lumenos CDHP was an option provided by my previous employer (a Fortune 50 company) that I had never heard of before, and when I was at the point of choosing plans, I couldn’t find much information about it, hence the reason I’m writing this. It seemed all my co-workers had opted for the more well-known PPO or HMO plan providers and I was the only one who was considering Lumenos.
I was looking for a health insurance plan that would cover my husband and myself, who are both in good health. I’d tried HMO and POS plans previously and really disliked not being able to choose my doctor and having to go to my primary care provider before being able to try a specialist. Their provider networks also seemed limited. My employer only paid part of the health coverage premiums, with the rest coming out of my paycheck each month. Given all this, Lumenos seemed to offer the most flexibility and options at the best price; in fact, it was cheaper than all the other options by a significant amount. So, why did no one use Lumenos where I worked?
How it worked
I guessed that part of it might be because the explanation provided in the benefits book we received was very complicated and not easy to read. Additionally, no one had really heard of a consumer-driven health plan before, just the usual HMO, POS, and PPOs. Moreover, Lumenos doesn’t make it easy to find information about it. It seems that you can’t access information on their site unless you’re already a subscriber, have a username and password to log on with or call them first to get login information. Not exactly helpful and easy.
Lumenos’s plans probably vary by employer, but I’ll give a brief and high-level summary of how my CDHP plan worked:
Each January, I was allotted a lump sum amount (called an “Employer HRA allocation”, where HRA stands for Health Reimbursement Account) of $1300 for an individual, or in my case, $3200 for a family (you just had to have more than one person to qualify for “family”, and the amount didn’t vary by number of members) for one year. During that year, I was able to apply this amount toward doctor’s visits and many “extras” that are covered by the plan, such as vision providers, eyeglasses, contacts, or even lasik, things that typical insurance plans wouldn’t cover. Even better, preventive care visits were free-of-charge, meaning I didn’t pay for them out-of-pocket, and they did not get charged against my lump sum balance either. Whatever I didn’t use at the end of the year got rolled over into the next one. Every January, I’d get another $3200 HRA allocation, and these would just accumulate each year up to a maximum of $9600 until I’d used them up.So, my non-preventive health care costs would charge against the $3200 or however much I had accumulated in my HRA allocations to date. But what would happen if I had an accident or illness that cost more than what I had available in my allocation? Then the balance remaining of the HRA would be applied against those costs, and I would be responsible for the remaining costs out-of-pocket up to a certain amount, or what Lumenos calls the “bridge”. In my plan’s case, this annual bridge amount was $1600.
As an example, suppose I had an illness that cost $5000 of service and had $3200 in my HRA. Then I would first apply the $3200 toward the $5000, then pay the $1600 bridge amount out-of-pocket, and Lumenos would cover the remaining $600 at 90% (or 70% for providers not providing a discount). I would also be responsible for the $60 or 10% that Lumenos didn’t cover, called the coinsurance. For families, coinsurance maxes out at $400 and at $300 for individuals, so if you do the math, you can see that maximum out-of-pocket expense each year under the plan is $2000 for families, comprised of the $1600 bridge and $400 coinsurance maximums.
If I later that year I had another illness that cost $4000, then Lumenos would then cover a total of $3660 of that, since I would only be responsible for the $340 remaining to hit my maximum coinsurance responsibility. Thus, once I max out my coinsurance and pay my bridge, Lumenos covers everything else at 100% for the remainder of the year.
Hmm. Reading back, I realize this explanation is still not exactly straightforward, but suffice it to say that Lumenos was a great choice for couples and individuals who were in good health because it was so flexible, reasonably priced, yet provided 100% coverage in the case of serious medical care. Got neck pain? You could go directly to a specialist and even get massage therapy fully covered by your allocation for the year until you used it up.
Ease of use
Lumenos also offered extensive online resources for those of us who were internet-inclined. You could check the status of your claims, your remaining HRA balance, download plan information, find providers and doctors, all from the lumenos.com website. Nice!
We never had any trouble with paperwork or submitting claims. All the forms were available on the site, and we always reached a rep to speak to on the phone with little wait, all in all a very good experience.
So, that’s my review. I was very happy with Lumenos and recommend it highly at least for people in a similar situation. I can’t speak for those who have children or who may have chronic illness as to the appropriateness of Lumenos or CDHP. As a side note, Lumenos started offering a High Deductible Health Plan, HDHP, for families that ended up being a better option for my coworkers who had children. Though I don’t know how or how well this version of the plan worked, you may wish to check and see if your employer provides this option and whether it works better for you.
I think the burgeoning CDHP insurance revolution (if you can call it that) is a good thing, and definitely better than traditional HMO and PPO options, though granted, it may still not be the ideal solution to solving health care costs in the US. After all, the allotted money isn’t your own, and that sets up the incentive to spend (perhaps sometimes unnecessarily) on services and “extras” that you may not need. The goals patient, provider, and payer of medical services are still not aligned under this setup.
Personally, I might even go for an insurance plan that gave me more control, provided less allocations, but was cheaper and still provided excellent coverage for serious illnesses than Lumenos CDHP, but this is a good start.