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FAQs
Before Buying Healthcare Plans
Please
note that each insurance company and provider
network has different procedures and benefits.
The following answers to questions are generally
the rule, but are not necessarily true for all
healthcare plans. For specific information, please
consult brochures and contracts supplied by companies
in which you have an interest.
Questions
about Healthcare coverage
-
What
is the first thing I should know about buying
health coverage?
-
Can
I buy a single health insurance policy that
will provide all the benefits I’m likely
to need?
-
I’ve
had a serious health condition that appears
to be stabilized. Can I buy individual health
coverage?
-
What is an HMO?
-
How does an HMO work?
-
What are the advantages of HMO plans?
-
Are there any drawbacks to HMO plans?
-
What
is a Point-of-Service Plan (POS)?
-
How does a POS work?
-
What are the advantages of a POS?
-
Are there any drawbacks to a POS?
-
What
is a PPO?
-
How does a PPO Plan work?
-
What are the advantages of PPO Plans?
-
Are there any drawbacks to PPO Plans?
-
What
is Indemnity insurance?
-
How does an Indemnity Plan Work?
-
What are the advantages of an Indemnity Plan?
-
Are there any drawbacks to Indemnity Insurance?
-
I
have a physician—is he/she affiliated
with this plan? What do I do if he/she leaves
the plan?
-
I
don’t have a primary-care physician now,
or wouldn’t mind changing—how will
I choose one, and which physicians may I choose
from?
-
How
does the plan select physicians?
-
How
easily can I change primary-care physicians?
-
How
will specialized care be arranged?
-
Can
I use a specialist as my primary care physician?
-
My current health is excellent. I have no problems
that I’m aware of. Why should I select
a primary care or personal physician now?
-
I
have a preexisting condition–will the
plan cover it?
-
I’m
taking a specific medication–will the
plan pay for it?
-
What
if a course of specialized treatment is recommended
for me by my physician–will the plan approve
it?
-
I
have an ongoing or chronic condition–how
will the plan treat it?
-
If
my goal is to improve my health by: increasing
exercise to stay fit; losing weight; stopping
smoking, will the plan help me do that?
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What benefits are covered, and what are the limits of
coverage?
- What
types of preventive care, such as immunizations and
health screenings, are covered?
- What
about therapies like acupuncture or chiropractic services?
- Are
experimental or investigational treatments covered?
- How
will I know which prescription drugs are covered?
Questions
about Quality
-
What kind of accreditation (voluntary third-party review
of a health plan’s policies and procedures) has
the health plan received?
- How
do I know my plan provides high quality care?
- How
many complaints were filed against the plan or physician
in the last year, and how many were upheld?
- How
do consumers rate the health plan in independent surveys
bybusinesses/consumer groups?
Questions
about Service
-
What do I have to do to see a specific institutional
provider (e.g., hospital, laboratory)? What kind of
approval is required before a primary-care physician
can refer a patient to a specific provider?
- Do
I have the option of going outside the plan for specialized
care?
- What
do I do if I have an emergency and want to go to the
emergency room?
- What
do I do if I need urgent care at night/on weekends?
- What
do I do if I need care while traveling?
- What
do I do if my child needs care while away from home
(e.g., while at college, traveling, etc.)?
- How
far will I have to travel for routine care?
- How
easily can I get help over the phone?
- What
happens if a treatment is recommended and the health
plan refuses to authorize it or if I have a complaint
about the service I receive from my physician or health
plan?
- What
percentage of members leave the plan each year?
-
What will my monthly premium be?
-
Who
is covered by my health plan?
-
What
out-of-pocket costs should I expect to pay?
OTHER
FAQS:
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