Easy Steps to Choosing a Benefit Plan
Every year your company makes changes to their benefit plans. Some years the changes are small (and everyone is happy). Other years the changes are significant and the options can seem complicated. If you have to decide between various benefit plan options this year, following these steps can help. We have broken the steps down into “understanding” and “analyzing”. Please remember to follow these steps for you and for any of your family members covered under the benefit plan. You probably have a choice between several health insurance carriers who offer different types of benefit plan designs.
Understanding:
1) Write down the major healthcare visits that you have had over the last 12 months, what they were for and which hospital or doctor (provider) you used
2) If you have ongoing healthcare needs, write down what healthcare you expect to need in the coming year along with the provider that you expect to use
3) List the preventive services you expect to have in the coming year, such as colonoscopy, mammogram, etc.
Analyzing:
1) Review the coverage that each plan provides for your types of healthcare needs.
For example, if you have diabetes:
a. What is the coverage for diabetic supplies?
b. Does the plan cover nutritional counseling for diabetes?
If you expect to deliver a baby in the coming year:
a. How does each plan cover prenatal care?
b. Is there an inpatient deductible that you will have to meet for the delivery? If so, what is the co-insurance level of coverage once you have paid that deductible?
2) Look at the list of doctors and hospitals included in each plan’s network and compare it to the doctors and hospitals you currently use. Where is the best match?
3) Understand the difference between in-network benefits (when you use a network provider) and out of network benefits (when you do not use a network provider).
4) Verify what the national coverage is for emergency situations when traveling.
Understanding:
Write down the prescription drugs you take consistently, indicating whether they are brand or generic
Analyzing:
1) Carefully review the prescription drug coverage that each plan offers, including deductibles, co-insurance and plan limits.
2) Confirm whether the brand name drugs that you take are on the formulary list for the plan. This information will probably not be in the printed materials.
One more thing:
Many insurance companies now offer technology tools that give you:
1) The ability to check the status of claims payment on line
2) The ability to go on line and see whether a doctor or hospital participate in their network
3) Wellness information
Take a few minutes to research and compare the tools offered by each of your insurance plan options.
Decision time!
Which of the plan and benefit options matched your needs based on the above?
Which of the plan and benefit options matched your family’s needs based on the above?
That’s the Answer!
This information brought to you by Patient Care at (866) 253-2273.
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