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Comparing
Plans - Buying Wisely
Whether you end up choosing a fee-for-service plan or
a form of managed care, you must examine a benefits summary
or an outline of coverage—the description of policy
benefits, exclusions, and provisions that makes it easier
to understand a particular policy and compare it with
others.
Look
at this information closely. Think about your personal
situation. After all, you may not mind that pregnancy
is not covered, but you may want coverage for psychological
counseling. Do you want coverage for your whole family
or just yourself? Are you concerned with preventive care
and checkups? Or would you be comfortable in a managed
care setting that might restrict your choice somewhat
but give you broad coverage and convenience? These are
questions that only you can answer.
Here
are some of the things to look at when choosing and comparing
health insurance plans.
Health
Insurance Checklist
Covered medical services:
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Inpatient
hospital services
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Outpatient
surgery
-
Physician
visits (in the hospital)
-
Office visits
-
Skilled
nursing care
-
Medical tests and X-rays
-
Prescription drugs
-
Mental health care
-
Drug
and alcohol abuse treatment
-
Home health care visits
-
Rehabilitation facility care
-
Physical therapy
-
Speech therapy
-
Hospice care
-
Maternity care
-
Chiropractic treatment
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Preventive care and checkups
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Well-baby care
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Dental care
-
Other covered services
Are there any medical service limits, exclusions, or preexisting
conditions that will affect you or your family?
What
types of utilization review, pre authorization, or certification
procedures are included?
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Costs
How
much is the premium?
$_____________________
/ month / quarter / year
Are
there any discounts available
for good health or healthy behaviors (e.g., non-smoker)?
___________________________________________
How
much is the annual deductible?
$_____________________
per person
$_____________________
per family
What
coinsurance or copayments apply?
_____________%
after I meet my deductible
$____________
copay or % coinsurance per office visit
$____________
copay or % coinsurance for "wellness"
care (includes well-baby care, annual eye exam, physical,
etc.)
$____________
% copay or coinsurance for inpatient
hospital care
For more help in comparing
health plans -- view our Health
Insurance Coverage Worksheet
| Note:
Worksheet is in PDF format. If you need Acrobat
Reader. Click link to download for free: |
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