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.
Some Background
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.
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Ron Stubblefield
Ricemutt,
I am too facing changing insurance plans with a new employer who offers Lumenos. After moving from Texas to Oregon for my new job I found the same United Healthcare PPO rates had doubled, making it darned-near impossible to even afford the bi-weekly premiums. Luckily, after reading your article and delving further into what Lumenos has to offer, my wife and I are choosing Lumenos because of the flexibility (and affordability) that you speak of. We are all in good health and only have a couple of monthly prescriptions between the two of us.
Thanks for your candid opinion!
~Ron
Ricemutt
Glad to be of help — I hope the plan works out for you too. Good luck on the new job!
chocolatefondue
Thank you very much for writing about this plan. I am in a similar situation and have been wanting to know more about it. After reading the comments, I can finally decide.
Lumenos vs. Aetna PPO ยป
[…] Finance, Insurance Since switching employers, my husband and I have also switched insurance providers. We chose a PPO plan because we like the flexibility it gives us, but I wanted to write a follow up to my original review of Lumenos CDHP so that I can give some more concrete comparisons. Keep in mind that our situation (a healthy, relatively young couple, with no chronic health problems) may be different from yours. Still, overall, I still much prefer Lumenos, as you’ll see below. I plan on updating the table as things arise. […]
chuck
For all you positive-thinkers about the Lumenos plan, I only have one thing to say:
Wait until a member of YOUR family is DENIED coverage on a desparately-needed surgical procedure & device that has been FDA approved for two years and which offers exponentially better long-term outcomes and quality of life than the “traditional” procedure.
It is THEN that you will get the shock of your life. You cannot imagine the pain and grief this has put my family through.
It simply proves the old saying, “You get what you pay for.”
If you are ‘covered’ by Lumenos, pray that you never need it for anything major.
Ricemutt
Chuck, I’m honestly very sorry to hear the difficulty and hardships your family must be going through. As mentioned above, we had Lumenos coverage but were in good health, so we never really put its coverages to the test. My post was just my review of the plan I had, and given our circumstances.
I don’t represent Lumenos or benefit from them (in fact, we’ve since switched to Aetna PPO due to change in employers), but I get the impression from my stats page that they do read this page and feedback. If you have a site or story you’d like me to link to, I’d be happy to try to present another point of view so people have a better idea of what they might be facing.
Michelle
I was briefly on a similar plan through Definity Health. I didn’t know then to call it a CDHP–now I will know the acronym when I see it. Definity also had a reimbursement/savings account, then a region of “member responsibility” (similar to a deductible, except that you don’t owe it until your reimbursement is gone), then they kicked in a proportion of what was left. I was only on it for a month, but I do recall them sending plenty of material to help orient the new members and do not recall having problems with the process aside from the paradigm shift. Other than that, they did not seem to “babysit” the consumer a whole lot.
Side note: if you have a choice in plans, always do the math first, especially if you have some predictable costs (e.g. maintenance medication). Also consider the effect on your financial stability should you have illnesses. I remember this period right after college as being tough, but in particular paying over $300 a month in COBRA while earning $10/hour temping was difficult–however, this was not as difficult as the possibility of becoming ill before I could be insured, so I kept paying it!
Chuck, I understand that things like this happen with all insurance companies. I wonder if anyone has a table comparing common different insurers’ coverage of various treatments (just for a broad idea). I’ve spent some time on Google but haven’t turned up anything yet, maybe will think of different query terms in my sleep.
Anon
Don’t use Lumenos! Through my employer I enrolled my family and I in Lumenos 4 months ago and, despite repeated attempts on the part of both myself and my employer, I have never received a Lumenos ID card or an enrolment package, etc. Since one can neither telephone nor log-in to one’s account without the crucial info on the card, I have no way to reach Lumenos. Further, one can only file claims by mail (rather than by fax), and without a card one cannot use the telephone menu, so there is no way I can check on the processing of a claim.
As a result of problems like this, my employer has since cancelled its contract with this appallingly run company.
Beverly
I no longer have Lumenos, but now am getting bills from a service done in 12/14/05 that should have been fully covered. I can’t even find a phone number to call and inquire on their website! If you absolutely do not have any heath issues, it might be worth it, but honestly, it is not a plan that offers any comfort for that unplanned emergency all of us face.
Mike
My employer is pushing Lumenos too. But after careful examination of their brochure I seems to me I will/could pay significantly more annually with Lumenos. Does anyone else see this?
Terry
This is a good source of information, thank you for writing it and sharing. Like above, I am in a similar situation.
joann, houston
Hello all, I recently contacted Lumenos (as I no longer am with them either), and they were more than courteous & helped me out. Their number is 1-866-842-5558.
Good Luck, joann
James
The math doesn’t add up in your example. Applying 3200 and 1600 against the 5000 leaves you with 200, not 600 as you state. Because of that mistake, the rest of the calculation is skewed. Please redo.
A
I have Lumenos through a company that I am in the process of leaving. The insurance has been good covering my daughter’s Physical Therapy from a prior company covered surgery. I am leaving the company in not the best terms because I feel the job does not treat their employees ethically. Does anyone know how this will affect the Lumenos coverage if the company already paid their balance and I have almost spent my bridge amount. There are no more claims to process. By law I know I am to be covered until the end of the month. Does anyone know how Lumenos handle this?
c williams
——-someone PLEASE assist me
me in getting the telephone number for
this insurance company! I’ve all but
given up on trying to find it! Not sure why
its sooo difficult to find. Don’t they want
people to call them!
PLEASE HELP!
Klementyna kolty
Blue Shield Medicare Supplement – Get information on zero cost Blue Cross Freedom Blue, Medicare Supplements, AARP, and under 65 individual and family plans 1-800-356-3615.
Sally
Your safest bet to find Lumenos would be to contact Blue Shield in your region or state. Anthem is a provider of Lumenos. Also CDHP or Group Health. Lumenos is the name of the plan, the company name who owns it is probably different.