Health insurance comes in so many flavors that it can be challenging to choose the right plan for yourself. What’s more, without enough information, you may end up with the wrong one.
By wrong, we mean one that doesn’t cover the situations that you’re most likely to find yourself in. The truth is, most of us would select an affordable option without stopping to think if it gave us the cover we require. Also, some people may think that if a policy suits their neighbor, it will suit them too. But choosing a plan without giving your needs a second thought is the wrong way to go.
We present some insightful information on health insurance policies below. You can ask your insurer these questions to ensure you pick the right plan:
1. So, what kind of plan am I looking at?
For starters, begin by asking your potential insurance agency if a plan is an indemnity health one or a managed care system.
With the former, you pay a certain percentage of the costs you incur. The insurance company will pay the remainder. That’s also why the indemnity plan is called a fee-for-service plan. Usually, you can choose the doctor.
For managed care, the out of pocket expense is minimal. They come through either a health maintenance organization or a PPO, i.e., a preferred provider organization. But the two aren’t the same. For instance, you can’t see a doctor outside the HMO’s system. And you – or your employer — pay part of the monthly fee. With a PPO, on the other hand, you can pay more to see a doctor outside the system. Moreover, you receive discounts if you stick to the ones within the system.
2. And how much do I pay?
When we talk about the , you need to know the difference between the following three terms:
- Premium is the first insurance bill that arrives at your door. By paying it, you retain coverage. So, for instance, if the premium is $200, you’re paying $2,400 annually.
- Deductible means the amount you must pay before the plan kicks in. So, with a $3,000 deductible, the bill needs to exceed that amount if you expect the insurance company to pay.
- Out-of-pocket max means the highest you need to pay. The company picks up the remaining bill. Say, you get a bill amounting to $55,000. Should the max amount be $5,000 that is what you’d pay.
Moreover, it becomes $2,000 if you’ve already crossed $3,000 off your deductible.
3. What limitations should I be looking at?
Other than the policy limits, you should also look at conditions or situations that your policy won’t cover. For instance, you should ensure they have coverage for when they see an out-of-network doctor.
Similarly, companies also have rules regarding pre-existing chronic illnesses. Therefore, if you have to spend on medical costs related to that condition, the policy may not kick in at all – or for a few months.
In short, read those terms to ascertain how extreme the coverage restrictions are.
4. And what about when I am away from home?
Say, you’re traveling. Don’t think that any medical expenses automatically fall within the policy coverage you have. It is better to confirm who will be shelling out the cash should you need to seek medical attention while away from home.
Additionally, ascertain how much your plan will cover and when – meaning the duration, after which the company will reimburse you.
5. What must I discover about how you handle claims?
Sure, the insurance seller will tell you that you can appeal any claims their company denies. However, the procedure may vary wildly. For instance, some companies say you must take the case to an arbitrator.
Aside from that, it is also essential that you be aware of the average turnaround time for such claims and appeals.
6. What happens if my needs change?
You may expect such a change, or it can be a surprise. Either way, ask the company if your plan will grow with your needs or not. For instance, new jobs, marriages, babies, and serious health conditions can all happen at any time.
Additionally, while you ask them, make sure you cover the same points with yourself. Do you expect things to alter in the coming year? If you do, then select a policy that will evolve with your healthcare needs.
7. Whom do I call for answers to my questions?
A customer service team is something that all your prospective insurance carriers should have. Hence, any queries about claims and bills can be answered readily. Ask the carriers who you’ll find at the other end when you call with such questions – a machine or a representative.
In the end, we’d advise making a check-list of these questions. Keep it close as you analyze the new policies. Recheck before you sign the documents!