10 Areas of a Health Insurance Plan

What do you really need to know when deciding which health insurance plan is appropriate for you?  While the information is most times segmented into individual, family or group coverage, there are many other factors that impact your insurance selection.  Selecting the wrong plan can leave you under-insured and resulting in catastrophic loss when hit with a major medical issue.  Review these 10 areas to know what to look for in your health insurance plan.

1)  Prescription drug coverage  Depending upon the type of insurance plan you select, you will want to know if you will be adequately covered.  Especially if you are already taking prescription medication on a regular basis, you will want to know which drugs are covered. In most cases, you will want a plan which includes co-pays and includes the ability to choose between generic or brand name. If you are prescribed a newer or experimental drug, you will need to do some research as many companies wont cover these costs.


 

2)  Preventive services costs  these include services like annual exams, tests and screening including routine immunizations.  Many times services like these are also on a co-pay system.  Besides knowing what type of service is covered, youll also want to know how much youll have to pay.

3)  Office visits  these include visits that are not covered under preventive services.  One thing youll want to find out is if youll be able to use your regular doctors.  If you currently use an HMO, you may only have the choice of participating providers.  If you are using a PPO, you are normally free to consult with any doctor. In most cases, you can check to see if your doctor is covered under your plan before you buy.

4)  Imaging and laboratory services  these include testing and interpretation of results for services like CAT scans, MRIs and x-rays. Many plans include a discount program where you get these services at a discount rate when used by an independent company such as Lab One.

5)  Outpatient services  these include in-and-out services that do not typically require a hospital stay.  They cover facility costs and the costs of supplies that you would need during your treatment.

6)  Emergency room services  these include the use of services and supplies for the emergency room.  This may or may not include ambulance services and supplies. Most plans charge an access fee to use the emergency room unless you are admitted.

7)  Health care practitioner services  these include the services of a specialist such as surgeons, anesthesiologists, assistants and nurses.  Besides costs, youll also want to know how easy it will be to see a specialist.  Will you have the flexibility of choosing a doctor on your own or will you need to have a referral

8)  Outpatient physical medicine these include things like physical, speech and occupational therapies as well as rehabilitation services including chiropractic care.

9)  Inpatient hospital these include the use of hospital care room and services as well as supplies and equipment.

10)  Other services these vary greatly from plan to plan and carrier to carrier.  These services may include dental, vision, other specialized care and surgery, behavioral health and substance abuse and home care.

One other major factor that wasnt mentioned earlier was that of the overall plan costs.  These costs include annual premiums, umbrella deductibles as well as embedded deductibles.  When planning for your annual medical expenses, youll need to estimate the cost of your premiums as well as any co-pays or non-covered payments that you might have to make.  In addition, youll also need to keep track of the umbrella and embedded deductibles to make sure you still have adequate coverage throughout the year.

Review these 10 areas to insure you properly review your health plan coverage.  Youll also want to review your plan at least annually to ensure it provides what you need.