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What You Must Know About Your Health Insurance Plan
By: Kay Lowe
Health insurance coverage is something you typically don't give much thought -
that is, until you or someone you love needs it. This very thing happened in my
family. My huband, son and I carried group health insurance from my husband's
employer. Shortly after we married, I persuaded my husband to switch from the
Blue Cross plan (80/20) to the HMO offered by his employer. Premiums for the HMO
were somewhat lower and there was better coverage for doctor visits and
pharmacy.
Within 2 years of switching health plans, my husband was diagnosed with
lymphoma, a slow-growing cancer. The prognosis was good, but treatments,
medications, and hospital stays were exhoribitant. Medical expenses would have
been overwhelming had we not switched to the HMO plan. Our HMO health insurance
plan covered almost all expenses we incurred with his illness. We basically only
paid our co-pays, and, of course, our premiums. In fact, our health plan still
pays for his treatments.
Should everyone change to an HMO health insurance plan? Not necessarily. What is
important is to know basic facts about our health plan. Important questions to
answer include:
What does the health plan cover? Does the coverage meet your needs? Some plans
do not include wellness care and preventive care, while others do. If you
require many prescription drugs, are these included in your plan?
What does the health plan NOT cover? Health insurance plans usually do not
include cosmetic surgery (unless the surgery is reconstructive, repairing damage
from burns, an accident, etc.). Major medical insurance plans will only cover
hospitalization and other "major medical" expenses.
Who does the plan cover? Family coverage includes immediate family in most
cases, spouse and minor children. Are children covered while in college, for
example? Are stepchildren or children in custody of the other parent covered?
Some health plans cover any child in the family, some cover stepchildren
(usually only if they live with you, however). Some plans only cover children
who live under your roof. What about foster children, or other children under
your care (grandchildren living with you, etc.)
How much are co-pays and deductibles? Most managed care plans require co-pays
whenever you receive health services, but may require no deductible. A
fee-for-service plan typically includes an annual deductible as well as co-pays
for services received.
What health care providers (doctors, pharmacies, durable medical equipment) are
covered under your health plan. Most managed care plans (HMOs, PPOs) utilize a
"network" of contracted health providers and may not cover providers out of
their network. If choice of health care provider is important to you, you should
ensure that your providers are in the plan network, or choose a fee-for-service
(FFS) plan that covers any provider.
These are just a few questions that you should consider if choosing a health
insurance plan. Information about your specific health insurance coverage is
very important to have. The last thing you want to be concerned about in an
urgent or emergent health situation is "is this covered by my health plan? Be
prepared by knowing basic facts of your particular health insurance plan.
Here's to your continued health!
About the Author:
Kay Lowe holds a Master's degree in health care and has 30+ years in the health
care field. She is also webmaster for http://Health-Infosource.com, a website
dedicated to disseminating health information.
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