Answer These Questions Before You Choose Your Health Insurance

October 8th, 2007 | by rachel |

   For millions of workers who receive health insurance through their employers, it’s OPEN ENROLLMENT time.   That means that it is time to use their knowledge about their health and medical care needs today to make the best predictions they can about the health insurance plan that will best meet their health and medical care needs in 2008.  It is a very important task.  It is also a very confusing task.  Most workers will receive a large, heavy, unwieldy packet in insurance information regarding the plans that are available to them.  Often, that information is just the beginning of what they really need to know to make the best choice.  Answering the following questions will help fill in the gaps and allow workers to get the most from their health care dollars.

1.  WHAT IS THE TOTAL MONTHLY COST FOR THE PLAN?

   A recent survey conducted by Benefit Sources & Solutions found that “The average annual health plan cost per employee is $6881…”  Health care costs, in general, are rising every year and so are the costs to employers that provide health care coverage.  Employers pay, on average, $3700 per employee of the total yearly cost and they are not mandated to do so.   As an employee, it is important to know what your coverage costs so that you can appreciate the investment your employer is making in you as well as being aware of what you COULD have to pay. 

2.  WHAT COSTS WILL YOU BE RESPONSIBLE FOR AND HOW MUCH WILL THEY BE EACH MONTH?

  • contribution to the monthly premium
  • copayment for services provided
  • % of services rendered
  • other out of pocket expenses

3.  WHAT TYPE(S) OF PLANS ARE AVAILABLE?

4.  WHO NEEDS TO BE COVERED BY THE PLAN?

   If you are the only person that needs to be covered, your costs will be relatively low.  If you have a spouse and/or children that need to be covered, you will pay a much larger portion of the total premium.  If you and your spouse have access to insurance through employers, you will need to evaluate both plans and see which one fits your situation the best.  If you do not have children, it may be more cost-effective for each of you to maintain single coverage with your respective employers.

5.  WHAT SPECIFIC MEDICAL NEEDS DO YOU HAVE THAT NEED TO BE COVERED?

   If there are chronic conditions that require ongoing medicine and/or treatments, you need to check the available plans for specific coverages involving those conditions.  If you know that you will need surgery, dental work, new glasses, etc. during the coming year, check to see how those situations are handled within the plans you are evaluating.  If you are planning to have a baby, make sure those costs are part of the plan you choose.

6.  WHAT IS THE REIMBURSEMENT PROCESS?

   Know what paperwork you will need before, during and after your medical care.  Also, be aware of how long you should maintain records of specific care.

7.  HOW ARE “OUT OF NETWORK” SERVICES HANDLED?

   This is particularly important to know when traveling.  If you (and/or your children) are out of town and need medical attention, what process needs to be followed?  Do you need authorization for visiting walk-in clinics?  If there a time requirement for notifying the insurance company of a medical service that was received?  Do the same co-payments apply?  You will definitely want to know these details BEFORE you leave town for business or pleasure.

8.  CAN I CONTINUE USING MY EXISTING DOCTORS?

   Some plans dictate which doctors you can use and still be covered.  If you have existing relationships with doctors that you do not want to give up, make sure you choose a plan that does not limit your choice of doctors.

9.  WHAT OPTIONAL COVERAGES ARE AVAILABLE?

10.  ARE THERE MULTIPLE LAYERS OF COVERAGE?

   Some plans are structured to allow coverage for different types of families (single parents + children; up to a specific number of dependents, etc.).  If your plan has multiple layers of coverage that you qualify for, take the time to run the numbers and see which layers gives the most coverage for the money.

11.  WHAT WOULD IT COST FOR ME TO PURCHASE HEALTH INSURANCE INDIVIDUALLY AND/OR SELF-INSURE?

   Depending on your health and medical needs, it COULD make sense to buy insurance on your own or put money away to pay for all medical expenses out of pocket.  In very rare cases, you may find that these options would be cheaper than the insurance you can get from your provider.  Either if it is not a feasible option, it is worth knowing exactly what it would cost to buy insurance on your own.  Knowing that will prepare you for the possibility of having to buy your own insurance at some point and self-insuring could become a financial goal.

   Certainly, there is plenty of information available on all aspects of health insurance.  Here are some places you can go to find out more:

http://www.howstuffworks.com/health-insurance.htm

http://www.insure.com/articles/healthinsurance/basics.html

http://www.planforyourhealth.com/about/insurance101

The Kaiser Family Foundation

FamiliesUSA

corporate web sites of insurance providers

the INSURANCE DEPARTMENT web site for your state

  

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