FAQs | Choosing a Health Plan
Before you start reading the insurance brochures, take the time to make a list of questions regarding the issues that are important to you. If you can't find the answer, or you don't like the answer you get, move on to another brochure.
Q. Can I see my own primary care physician and specialists?
A. Different types of plans have different rules about which doctors you can see. If you can't find the answer in the insurance brochure, request a list of participating doctors. Before you sign up with any plan, ask your doctor if he/she is still affiliated with that plan and can refer you to the specialist of your choice.
Q. If you have an ongoing health problem or condition, how will the plan cover it?
A. Some plans let you see specialists (like orthopedists or allergists) as often and for as long as you want. Others require an authorization that is based on the referral being medically necessary, according to your primary care physician's judgment. If you take medications, prescription coverage is important. Some plans also have different pre-existing condition restrictions. Read the fine print.
Q. Is maternity care covered?
A. Check your plan for coverage of routine checkups, screening tests, and prenatal educational classes.
Q. Does the plan cover preventive care for my children?
A. Plans vary in the coverage of periodic physicals, immunizations and school physicals.
Q. Do I have to fill out claim forms?
A. As a general rule, when receiving covered services, HMOs do not require you to complete claim forms. For Point of Service (POS) and PPO plans, when you visit participating providers and have obtained necessary authorizations, claim forms are not generally required. Indemnity plans usually require you to do the claim form paperwork.
Q. Is the least expensive plan always the best buy?
A. First, start with a plan that offers coverage to match your needs. All else being equal, only then should you consider the cost. You'll need to look at the monthly premiums versus out-of-pocket costs (deductibles and co-payments) to determine what will cost you the least as you use services during the year.
Q. How can I minimize out-of-pocket expense and maximize coverage to receive the highest level of benefits available?
A. HMO, PPO and POS plans are generally less costly. Within those plans you can minimize out-of-pocket expenses by selecting participating providers and by obtaining referrals and authorizations when necessary.
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