For many Americans, simply finding an employer that offers health insurance is an accomplishment. As health care costs spiral, many employers have eliminated this once-standard benefit so many people are seeking out insurance on their own. Those lucky enough to be offered insurance may simply sign on the dotted line, feeling that any insurance is better than none at all.
This is not always the case.
Before signing up for insurance, it is important to know what you are getting into. All plans are not right for all people. If you determine that the offered insurance will not meet your needs, you have a few different options. One is to speak with your employer. You may be able to negotiate a different plan at a different cost to you. You can also look into private insurance plans that are offered directly to individuals, though these tend to be priced much higher. Additionally, if your spouse’s employer offers insurance, be sure to check into both policies. One may offer better coverage, or you may be able to combine your policies for maximum coverage. Be careful not to duplicate coverage, however, or both insurances may refuse to pay.
When investigating offered coverage, there are a few things that it is important to understand. What is the monthly premium, and will it be automatically deducted through payroll deduction, or will you need to make payment each month? What is your co-payment for doctor visits? What about for hospitalization? What is the annual deductible per person and per family?
Be certain that you understand exclusions. Will you be a member of an HMO or PPO? What doctors are in the network? Where is the nearest in-network hospital? What do you do if you need medical care while traveling inside the United States? What if you are in a foreign country? Do you need a referral to see a specialist? What do you need to do prior to going into the hospital?
Pre-existing conditions are often not covered. What constitutes a pre-existing condition? Additionally, certain medical procedures that are considered experimental may not be covered. Be sure that you understand what makes a medical procedure “experimental.”
Be sure that you understand exactly what types of care are covered. Are maternity benefits offered? What about well-baby care? Are vision, dental, and prescription medication plans available? What about mental health and substance abuse treatment? Are you entitled to one or two yearly physicals? For women, are you able to choose a gynecologist as your primary care physician?
What are the rules governing changing life events? Marriage and the birth of a child are events that will change your coverage needs. What will you need to do to add dependents to your plan? What will happen to your coverage if you retire? Are partner benefits available for those in a long-term relationship?
Be certain that you understand how your rates and benefits can be changed. Your employer may decide to switch providers. How much advance notice will you be given in that situation? The insurance company may decide to raise rates. Are you protected against rate increases for a certain length of time? Can your rates be raised individually or your coverage dropped if you are diagnosed with certain illnesses?
In many cases, employer-offered health insurance is the best solution. However, it is important to investigate group insurance just as closely as you would a private solution. Your employer will usually have a benefits office, with counselors who are specially trained to answer all of your questions. Read all documentation that you are given, and take the time to make an informed decision. Investigate all of your options, and you will discover the insurance plan that works best for your family.
Yes, there are a lot of little details so force yourself to take a deep breathe and slow down and focus on each item until you understand it and the options you have. Try to avoid getting a ‘I just want to get this over with’ type of attitude. This is important and you could save yourself a lot of stress and grief in the future should anything ever happen by taking time now.
Don’t be afraid to ask any questions you have. Your insurance agent is supposed to be working for you. He or she is not doing you a favor, your doing them a favor by giving them a chance to convince you to do business with them
Remember that you are the client. Don’t be rude, but do not be intimidated. It is your right to ask questions. Please do so.