Make Informed Decisions

All plans are not created equal. Conduct a side by side comparison of each of the plan benefits that you are considering.

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Health Care Shopping Tips

Compare Benefits:  All plans are not created equal. Conduct a side by side comparison of each of the plan benefits that you are considering. Look to see if the benefits meet your needs. Choosing the most expensive plan is not always the most cost effective way to shop. Just because a plan is expensive, doesn't always mean that it offers greater benefit. Review any limitations to the number of doctor office visits that the plan may have per calendar year. This is one of the ways that you can save.

Plans that place a limitation to the number of office visits per calendar year tend to cost less because if you exceed that number of visits, you will pay more for those visits. This means that your cost sharing is more. Check if the plan includes both generic and brand drugs. Check the deductible for the brand drugs. Some are very high which contribute to a lower cost of the plan. See if the plan includes extra added benefits such as dental, vision and life insurance coverage. Be especially aware of the annual deductible and out of pocket maximum. Some plans include the annual deductible in the out of pocket maximum and some plans treat this as a separate amount. Remember, the out of pocket maximum is the maximum amount you would pay in one calendar year if something catastrophic happens (like hospitalization and\or surgery). Review other out of pocket expenses such as coinsurance percentages (which is a percentage you will be charged after you pay the plans annual deductible), co-payments (flat dollar amounts) and excess charges when provider charges are higher than the plans allowed amount.

Check the Drug Formulary:  Most plans offered now use a drug formulary. This is a list of drugs that will be covered by a plan. Be sure that the plan you choose covers any medications (brand drugs and\or generic drugs) you may be taking. Know if those drugs will be covered as brand or generic according to that specific health insurance company. More often than not a drug that you may know as generic may be a brand drug as far as an insurance company is concerned.

Check the Provider Directory:  All companies have a network of doctors and hospitals called providers. These providers are specifically contracted with the insurance company. Make sure any providers or medical facilities that you would likely visit are a part of the network to avoid "out of network" charges or charges that are not covered. Gone are the days where calling a provider and asking them if they accept an HMO or a PPO is simply not good enough. They certainly don't want to turn away your business. They will tell you that they accept HMO or PPO. Know that if they are not specifically contracted, you will be billed "out of network" and these charges will get very expensive. More importantly, ask if they are specifically contracted as an in-network provider with the particular HMO or PPO that you have. You can also research this information by company, by clicking HERE.

Underwriting Eligibility:  Underwriting eligibility guidelines vary between companies. Some are more lenient than others. If you have a pre-existing condition, you could be approved at a standard published rate, approved at a higher rate, offered an alternate plan, or declined. It may be worth your time discussing your particular pre-existing condition with your insurance professional before you apply. They can tell you about the general guidelines for your specific condition and how it could affect your eligibility. Thanks to healthcare reform, children under the age of 19 can no longer be denied coverage because of a pre-existing condition. Insurance companies can however charge a higher monthly rate based on their individual guidelines for those pre-existing conditions. During the application process, you may receive a telephone call from the carrier or a third party company requesting additional information from you. This is called a telemed or nurseline interview. They will simply ask you questions related to information found on your application that they need to get clarification on or information that they found in your medical history. It is important for an applicant to provide this information as soon as possible because the application process will cease unless the information is provided.

Application Processing Times:  Application processing times can vary between companies. Online applications can be processed more efficiently provided all necessary information is received. Applications can take anywhere from a few days, to several weeks depending upon your medical history. The more complete and detailed your answers are, the faster your eligibility can be determined.

Compare Premiums:  Monthly premiums are primarily determined based on your age, health history and where you live. Generally speaking, the more benefits that are included in a plan, the higher the monthly premium but not always. Plans that limit the number of office visits per calendar year and plans that have a high annual brand drug deductible can be less expensive. Just like plans with higher deductibles and higher out of pocket maximums and higher coinsurance percentages are also less expensive.

Coverage Out of State or Country:  If you travel out of state or out of the country, check with the plan guidelines carefully. Most plans will only cover you out of state (within the United States) during an emergency. Most plans will not provide coverage to you outside the country. Out of country travelers should seek travel medical insurance.

Exclusions and Limitations:  All plans have exclusions and limitations. Contact us for a complete list of common exclusions for the plan that you are considering. Contact us now at (800) 560-2443 if you need assistance in selecting a plan or you need assistance with enrollment. We are always here to assist.

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