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Thread: QualCare?????

  1. #1
    Registered User butttaflygrl383's Avatar
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    Question QualCare?????

    My job is switching from Aetna (100% infertility coverage) to QualCare (0% coverage) in January. Does QualCare as a whole not cover it. Or is my job just going with what is cheaper. Them switching really throws a wrench in my plans. Does anyone have QualCare? Do you like it? Have you had any problems with them?
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    Registered User Insurance Prof.'s Avatar
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    Default response to question about QualCare

    Hello, I see that this post is a month and a half old so you may know all this information by now. But I will post it anyway in case you don't, or in case it helps anybody else.

    A Little Background:
    QualCare (QC is not an insurance company in the traditional sense. They are a Third Party Administrator (TPA) and they administer the provisions of your company's plan. Your company is not a fully-insured, they are self-insured if they have a plan through QC. The way this works is the QC maintains a network of contracted providers (doctors, hospitals, etc) and they rent access to them at their negotiated rates to your employer.

    Every week QC notifies your employer that they owe $$$ for the medical claims of their members from the previous week (your employer does not have details of who used the benefits), and your company writes QC a check for that amount. QC then uses that money to pay the providers who rendered the service to the employees.

    Your Question:
    Because your company is now self-insured, they do not have to follow state insurance mandates (I assume you live or work in NJ?), they only need to follow federal mandates. Right now NJ has a state mandate that coverage for infertility must be offered, but there is no federal equivalent. SO - when your company sat down with QC to decide which benefits were going to be covered, it sounds like Infertility was one of the ones that got placed on the chopping block, usually as a cost saving move.

    Not every plan administered by QC excludes coverage for infertility though, so if you are ever moving jobs and that is a concern of yours, ask before you accept the offer.

    Sorry the news isn't good news, but I hope I answered your question. Best of luck in your future plans, I hope all turns out well for you.

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    Registered User Insurance Prof.'s Avatar
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    Default

    I just had an afterthought that I wanted to add.

    When there is little/no coverage for something like this (which can be pricey!) I always recommend that you put money into a Flexible Spending Account (FSA), if your company offers one. If it does, it lets you put a set amount of money (Usually around $3,000) into an FSA in pre-tax dollars. They take it out of your paycheck in equal installments throughout the year and you can use that money to pay for treatments, and while it may not be a lot it will save you from paying tax on that amount of money.

    If you are pursuing infertility treatment, you know in advance that you will spend at least that much, so you can be certain that it will not be wasted.

  4. #4
    Registered User butttaflygrl383's Avatar
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    Thank you for posting this. It's definitely clears things up for me. I wasn't getting anywhere in my search. Thank you again.
    Betty-28 Hidden Content DH-Billy-32
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    C1-provera induced-prenatals, DCI and FertiliTea-O'd CD22-24?
    C2-AF all by myself..YAY..prenatals-DCI 1200mg-FertiliTea-Soy Isoflavones CD3-7- O'd? idk I'm so confused
    Currently using inositol, vitamin d3, B-12, vitex, npc and prenatals.
    Hopes, prayers, crossed fingers & toes there won't be a cycle #3.
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