I had prepared a list which you may ask to your agent or to health insurance medical insurance company before opting any plan .
We basically know we have plans like Fee for Service Healthcare Insurance Plan, HMO Medical Healthcare Insurance Plan, PPO Health Plan.
Before opting Fee-for-Service Health Insurance Plans
*How much is the monthly health insurance premium?
*What will your total cost be each year? There are individual rates and family rates.
*What does the health insurance policy cover? Does it cover prescription drugs, out-of-hospital care, or home care?
*Are there limits on the amount or the number of days the health insurance provider will pay for these services? The best fee-for-service health insurance plans cover a broad range of health care services.
*Are you currently being treated for a medical condition that may not be covered under your new health insurance plan? Are there limitations or a waiting period involved in the health insurance coverage?
*What is the health insurance deductible? Often, you can lower your monthly health insurance premium by buying a health insurance policy with a higher yearly deductible amount.
*What is the coinsurance rate? What percent of your bills for allowable services will you have to pay
*What is the maximum you would pay out-of-pocket per year? How much would it cost you directly before the health insurance company would pay everything else?
*Is there a lifetime maximum cap the health insurance provider will pay? The cap is an amount after which the health insurance company will not pay anymore. This is important to know if you or someone in your family has an illness that requires expensive treatments.
Before opting HMO Health Plans
*Are there many doctors to choose from in the HMO plan? Do you select from a list of contract physicians or from the available staff of a group practice? Which doctors are accepting new patients? How hard is it to change doctors if you decide you want someone else?
*How are referrals to specialists handled?
*Is it easy to get appointments? How far in advance must routine visits be scheduled?
*What arrangements does the HMO have for handling emergency care?
*Does the HMO offer the health care services you want? What preventive services are provided? Are there limits on medical tests, surgery, mental health care, home care, or other support offered?
*What if you need a special service not provided by the HMO?
*What is the service area of the HMO?
*Where are the facilities located in your community that serve HMO members?
*How convenient to your home and workplace are the doctors, hospitals, and emergency care centers that make up the HMO network?
*What happens if you or a family member are out of town and need medical treatment?
*What will the HMO health insurance plan cost? What is the yearly total for monthly fees? In addition, are there co-payments for office visits, emergency care, prescribed drugs, or other services? How much are they?
Before opting PPO Health Plans
*Are there many doctors to choose from in the PPO health insurance plan? Who are the doctors in the PPO network? Where are they located? Which ones are accepting new patients? How are referrals to specialists handled?
*What hospitals are available through the PPO? Where is the nearest hospital in the PPO network? What arrangements does the PPO have for handling emergency care?
*What health care services are covered by the PPO plan? What preventive services are offered? Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other services that are important to you?
*What will the PPO health insurance plan cost? How much is the premium?
*Is there a per-visit cost for seeing PPO doctors or other types of co-payments for services?
*What is the difference in cost between using doctors in the PPO network and those outside it?
*What is the deductible and coinsurance rate for care outside of the PPO?
*Is there a limit to the maximum you would pay out of pocket?
Above mentioned questions are some questions which one must definitely ask or get to know before opting any plan . Now comes the question you have opted best available option . Now still you are not sure that you will get maximum benefit from your Medical Healthcare Insurance plan. Below is the thing which we always think after paying for something in this case maximum benefit after opting Health Insurance Plan.
How to Get the Most from Your Health Insurance Plan?
*Stay informed; read your health insurance policy and member handbook. Make sure you understand them, especially the information on health care benefits, coverage, and limits. Sales materials or health insurance plan summaries cannot give you the full picture.
*See if your health insurance plan has a magazine or newsletter. It can be a good source of information on how the health care plan works and on important policies that affect your care.
*Talk to your health benefits officer at work to learn more about your health insurance policy.
*Ask how the health insurance plan will notify you of changes in the network of providers or covered services while you are part of the health care plan.
Take Charge of Your Own Health Care
*Ask your doctor about regular screenings to check your health. Discuss your risk of getting certain conditions. What lifestyle choices and changes might you need to make to lower your risks or prevent illness?
*Ask health care questions and insist on clear answers.
*Ask about the risks and benefits of health and medical tests and treatments. Tell your doctor what you like and dislike about your choices for health care.
*Make sure you understand and can follow the doctor's instructions. You may want to bring another person along or take notes to help you understand things.
Keep Health Records
*Write down your concerns. Start a health log of symptoms to help you better explain any health problems when you meet with your doctor.
*Set up health files for family members at home. This will help you to monitor health care. Include health histories of shots, illnesses, treatments, and hospital visits. Ask for copies of medical lab results. Keep a list of your medicines, noting side effects and other problems such as other drugs and foods that should not be taken at the same time.
If You Have to Go to the Hospital
The time to find out what rules your health insurance plan has on hospital care is before you need it.
Planned Hospitalizations
Unless it is a medical emergency, your health insurance plan or primary care doctor will probably have to give advance approval (pre-admission certification) for you to go to the hospital. Otherwise, the cost of your hospital care may not be covered. Ask these questions:
*What hospitals are part of the health insurance plan network?
*Is there a limit on how long I can stay in the hospital?
*Who decides when I am to be discharged from the hospital?
*Will needed follow up care, such as nursing home or home health care, be covered by the health insurance plan?
*If I have a serious medical problem, will the health plan provide someone to oversee my health care and make sure my needs are met?
*Ask how your health insurance plan handles getting a second doctor's opinion on whether surgery or another medical treatment is needed. Are second opinions encouraged or required? Who pays?
Emergency or Urgent Care
If you have a true medical emergency, you should go to the nearest hospital as fast as possible. It is important for you to know what kinds of medical problems are defined as emergencies and how to arrange for ambulance service, if needed. Most health insurance plans must be told within a certain time after emergency admission to a hospital. If the hospital is not part of the health insurance plan network, you may be transferred to a network hospital when your condition is stable. Ask these questions:
*How does the health insurance plan define "emergency care?
*What conditions or injuries are considered emergencies?
*How does the health plan handle "urgent care" after normal business hours?
How do I get urgent care or hospital care if I am out of the area?
•How do I let the health insurance plan know, and how soon after I get the care?
"Urgent care" is for problems that are not true emergencies but still need quick medical attention. Check with your health insurance plan to find out what it considers to be urgent care. Examples may include sore throats with fever, ear infections, and serious sprains. Call your primary care doctor or the plan's hotline for advice about what to do. The health plan may also have urgent care centers for members.
If You Are Dissatisfied with Your Healthcare
Getting the best health care and services means understanding how your health insurance plan works, what your rights are, and how to complain if you need to. You have the right to get copies of test results as well as medical information about yourself. If you are in a managed care plan, you can ask to change your primary care doctor if you are unhappy with the relationship. You may also be able to switch health insurance plans during open enrollment.
Most health insurance plans have an appeals process that both you and your doctor may use if you disagree with the health plan's decisions. If your health care plan refuses to provide or pay for services, you can complain or file a grievance about any decision you feel is unfair-or you can appeal it.
You can contact the member services division of your health insurance plan for more information or to complain. Use your health plan's complaint process fully before taking other action. Be sure to keep written records of:
*All correspondence with the health insurance plan
*Health insurance claims forms and copies of bills
*Phone conversations: the date and time, the people you speak with, and the nature of each call
