What To Know and How to Find Out
Read and compare plans and contracts or evidence of coverage carefully so you will know exactly what is covered, what is not and the provisions and terms of the coverage. Always read and compare plan benefits and the provider network of physicians and hospitals you can use.
If your employer selects the plan for you but lets you decide your level of coverage, you will still need to review the terms of the coverage offered to decide what level is best for you.
Ask Questions about the Plan
- Do the services offered in the plan meet your needs and the needs of your dependents?
- What experiences have other people had with the health insurance plan you are considering?
- Does the plan ensure good medical care?
- How does the plan handle and resolve patient complaints?
- Has the plan been accredited by the National Committee for Quality Assurance?
- Does the plan cover preventive care such as immunizations, annual physicals, Pap smears and mammograms?
- How does your plan define and cover emergency care, urgent care and routine care?
- Does the plan cover preexisting conditions? Are there limitations? Do waiting periods apply?
About the Insurance Agent or Broker
- What are your agent's professional credentials? (CLU, CEBS, RHU, REBS, or others) Education? Background and years of experience?
- Will the agent/broker provide client references?
About the Insurance Company
- How long has the company operated?
- Is it financially sound? What rating does it hold? (A.M. Best Company, Weiss, Standard & Poor's Ratings)
- How many subscribers does the insurance company cover?
About Participating Physicians
- Is the plan's list of physicians current? Can you choose any physician on the list?
- Is a broad range of specialists, such as obstetricians, cardiologists and orthopedists, available in your plan's list of physicians?
- What is the physician turnover rate for the plan?
- How does the plan select these physicians? What is the credentialing process?
- What percent of licensed physicians are board certified for their specialty?
- Can you keep your current physician? If so, will it affect your out-of-pocket costs?
- If you have chosen a primary care physician, how easy is it to change to a different primary care physician if you desire?
- Can a gynecologist or obstetrician act as your primary care physician or gatekeeper?
And About the Participating Facilities
- Is the plan's list of participating hospitals current?
- Are the hospitals convenient to your home?
- How does the plan deal with out-of-town care?
- Is there a limit on how long you can stay in the hospital
- Who decides when you are to be discharged?
The cost of a health insurance plan should not be your only consideration.