Many people face the tricky proposition of choosing health insurance. To help wade through the process, here’s a list of ten questions you should ask before picking a health care plan:
1: What Type of Plan Is It?
Find out if it is a managed care system or an indemnity health plan.
Indemnity health plans: also known as fee-for-service plans, you pay a percentage of the medical costs, and the insurance company covers the remaining percentage. Typically, you are allowed to choose which doctors you use.
With managed care: meaning either a health maintenance organization (HMO) or a preferred provider organization (PPO), you have minimal out-of-pocket expenses.
- With an HMO, you or your employer pays a determined monthly amount for health-care services, but you can only use a doctor who is contracted with the HMO.
- With a PPO, you or your employer gets a discount if you use doctors within the plan. You may still go to a doctor outside the PPO system, but you will have to pay more.
2: How Much Will I Have to Pay for Medical Care?
Find out the amount of the premium. Then ask whether you will be charged a co-payment, and how much that is.
Alternatively, some plans may have a deductible (an amount that you have to pay before the policy starts to cover any medical costs.) Be sure to ask about this, and find out the percentage of costs that will be covered by the plan once you’ve met the deductible amount.
3: Will I be able to stay with my Current Doctors?
Ask about any limits on choosing your hospitals or doctors. Ask for a list of the hospitals and doctors that are covered, then decide if the plan is right for you.
4: What Benefits are there?
Ask if the plan covers vision care, dental, or other special services that you might need. Be sure to ask about prescriptions, too.
Definitely ask what benefits are not covered by the plan.
5: Will Routine Examinations be Covered?
Ask about pap tests, mammograms, immunizations and other routine check-ups.
6: Will I Have to Contact My Doctor Before Going to the Emergency Room?
Specific plans may require you to contact your doctor within 24 hours of going to a hospital emergency room, or your expenses won’t be covered.
7: Are there any Restrictions on Pre-Existing Conditions?
If yourself or a family member has a chronic condition, the policy may not cover related medical costs for a period of months, if ever. Ask for how long pre-existing conditions are excluded.
8: What Happens When I go away on Vacation?
If you need to go to the doctor while traveling, be sure to ask how much of the costs will be covered by the plan? How do you get reimbursed?
9: Is the Insurer Financially Stable, do they have a Good Reputation?
Find out how many years the company has been in business. You don’t want to get an excellent deal with low premiums, to find out that you can only see a doctor during limited hours. Read a few company reviews.
10: How Does the Company Handle Disputes Over Claims?
All insurance plans have procedures in place for appealing denied claims. Many require that you take your dispute to an independent person or an arbitrator who hears both sides and makes a decision about the claim.
Have Questions? Call: (214) 501.9613
