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Questions to Ask Before You Select a Health Insurance Plan

Many persons face the confusing proposition of selecting health insurance. To help wade through the piles of paperwork, you should ask for a list of top health insurance questions before choosing a health care plan:

1: What Kind of Plan Is It?

Establish whether it is an indemnity health insurance plan or a managed care system. With indemnity health plans, also called fee-for-service plans, you pay a percentage of the medical costs, and the insurance carrier pays the remaining percentage. You are allowed to pick your own doctors.

With managed health 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 make fixed monthly payments for healthcare services, but you can only go to a physician who is under contract with the HMO. Through a PPO, you or your employer gets a discount if you use doctors within the plan. You may go to a physician outside the PPO system, but you will pay more.

2: What is the Cost of Medical Care?

Determine the amount of the premium. Next, ask whether you will be charged a co-payment, a small flat fee, or possibly $10, charged for healthcare services.

Some health insurance plans have a deductible; instead, an amount that you have to pay before the policy begins to cover any medical costs. Find out about this and determine the percentage of expenses covered by the plan after you have met the deductible.

3: Will I Be Able to Use My Current Physicians?

Ask about any limits on selecting your doctors or hospitals. Ask for a list of the doctors and hospitals that are covered to decide if the health insurance coverage is correct.

4: What Benefits Are Included?

Ask if the health insurance covers dental, vision care, or other special services that you might require. Ask about prescriptions and benefits that are not covered by the plan also.

5: Are Routine Check-ups Covered?

Ask more concerning mammograms, pap tests, immunizations, and other routine check-ups.

6: Will I Have to Call My Physician Before Going to the Emergency Room?

Some plans necessitate you to contact your doctor within 24 hours of going to a hospital emergency room, or your costs would not be covered.

7: What Are the Health Insurance’s Restrictions on Pre-Existing Conditions?

If you or somebody in your family has a chronic condition, the policy may not cover related medical costs for a period of months — or ever. Ask for how long pre-existing conditions are omitted.

8: What Happens When I am Away from Home?

If you want to go to the physician while traveling, how much — if any — of the costs will the plan cover? How do you get compensated?

9: How Does the Insurance Carrier Handle Disputes Over Claims?

All health insurance coverages have procedures for appealing denied claims. Many want you to take your dispute to an arbitrator or an independent individual who hears both sides and makes a decision about the claim. Ask what the carrier’s average turn-around time is for resolving claim disputes.

Resources and References:

• Managing Costs of Chronic Conditions
• Health Insurance for Vision Coverage