The Best Health Insurance Plan For You
The following is a list of questions for you to consider when selecting a health plan. Use this guide as an information comparison so that you are better able to select the plan that will meet you and your family's health needs.
Providers
- How many primary care physicians are available in the plan?
- Can you use an OB/GYN or pediatrician as a primary care physician?
- Does the plan offer a comprehensive list of specialty physicians?
- Which hospitals can you choose?
- What is the geographic size of the health plan network?
- Does your chosen physician practice at your preferred hospital?
- How do you get coverage when you are out of the network or traveling on vacation?
- How do your work colleagues, friends, and family rank the plan based on:
- Access to desired providers
- Waiting time for authorizations
Benefits
- Which benefits are covered?
- Which benefits are excluded?
- What are the waiting periods and/or time-limits for pre-existing conditions?
- What is the dollar limit on annual and/or lifetime benefits?
- Are second opinions for surgical procedures and complex treatments covered?
- What are your outpatient prescription drug benefits?
- How are maintenance medications covered (like blood pressure medications),
- 60 day supply, or 90 day supply?
- How much do you pay per prescription?
- Do you pay a different amount for brand names prescriptions and
- generic prescriptions?
- How long can you keep your children covered as eligible dependents? What are the additional costs for this dependent coverage?
- What are the outpatient and inpatient psychological/psychiatric program benefits?
- What are the outpatient and inpatient drug and alcohol rehabilitation benefits?
Cost
- What amount of the monthly premium is your responsibility?
- What is the cost to you if you add additional members?
- What is your deductible amount?
- What amount do you pay for:
- An office visit?
- Outpatient services?
- Prescription medications?
- What are your costs if you receive service from out-of-network providers?
- What amount, percentage, or maximum do you pay for hospitalization?
- What is the maximum out-of-pocket costs per year?
Access And Convenience
- How long is the waiting period before coverage begins?
- Is your chosen physician's office or medical facility conveniently close to your home or work?
- Do you have options for seeing your physician in an office or a clinic?
- How long does it take to schedule an appointment?
- Do you need a referral and/or prior authorization to see a specialist?
- Will your physician or medical facility bill your insurance or are you required to file a claim?
Services Covered
Some of the services listed below are not covered by all insurance plans and/or may have time limits. Review the list and check the services that are important to you and your family. Then, review the coverage, life-time benefits, and out-of-pocket expenses for these services in the plans that you are comparing. In addition, see if the plans limit covered services to specific settings, such as laboratory testing, physical therapy, and radiological examinations.
- Ambulance
- Annual examinations
- Childbirth services
- Emergency services
- Fertility services
- Home health services
- Hospice care
- Long-term care (skilled nursing)
- Medical equipment/prosthetics/hearing aids
- Mental health/substance abuse services
- Physical rehabilitation services
- Prescription medications
- Prevention/wellness services - including well-baby care
- Transportation to and from appointments
- Urgent or walk-in visits
- Vision services
- Additional services
This above listing is a general guide and may not include all of the healthcare services that are available.
Why don't you touch tomorrow's healthcare technology today?
Contact your employer for plans that include Long Beach Community Medical Center and our affiliated physicians.
