Selecting the Policy

That is Right for You

Selecting the policy that is right for you involves more than finding out which policy is the cheapest! In addition to the cost, you should consider the amount you travel, the complexity of your health condition, your age and, how important "freedom of choice" is to you.

Remember, what appears to be "cheap" up front can turn out to cost more than you can afford when you can least afford it!

Here are a few options for medical insurance you should consider when selecting the policy:

  • Primary Care Physician. Will you have to change your current physician or is he/she a member of the preferred provider organization or HMO you are considering?

    If you have to select a new physician, you will not only want to assess the credentials of the physician you are selecting, but you should also note what days and hours he/she is available. If he/she is a member of a HMO they may have restricted availability.

  • Pre-existing Conditions. Ask to have the clause addressing "pre-existing conditions" highlighted. Even if you are not able to re-call any pre-existing conditions right now, you need to be very clear in your understanding of what is considered "pre-existing." You should be aware of how long a pre-existing condition may be excluded from coverage. What you may consider a "minor incident" your insurance carrier may consider a "pre-existing condition."
  • Specialist. Are you able to refer yourself to a specialist or do you have to have the pre-approval? If you are currently under the care of a specialist, does he/she belong to a network of physicians?

    If you are considering starting a family, you may wish to confirm what services are covered. Hopefully you will not need the services of an infertility specialist, but if you do, you will want to know what types of services are provided/covered under your policy and if there is a specialist available that will meet your needs.

  • Urgent/Emergency Care. Do you have unlimited access to emergency services? What does your insurance carrier or HMO define as an "emergency?" Is there likelihood that you or your family will have a frequent need for urgent or emergency care? Will emergency/urgent care be restricted by your HMO or insurance carrier? This is an important consideration when selecting the policy.
  • Prescription Coverage. You may not appreciate just how important a comprehensive prescription plan is until you are sick. Medication costs are sky rocketing. When you are sick, the last thing you want to have to worry about is whether you can afford to buy your medication!

    Consider when selecting the policy that if you are currently on medications, you will want to confirm that each medication will be covered by your insurance carrier or HMO group. You may even wish to have this confirmation in writing! Make sure that the policy does not force you to purchase generic medications. Do not be "cheap" when it comes to prescription coverage!!!

  • Routine Check-ups. Be sure your policy covers routine check-ups whether they are for well-baby checks, OB-GYN or physicals for adults and children. Although OB-GYN physicians are considered specialists, annual check-ups should be considered part of your routine care.
  • Services. Basic policies should also cover durable medical equipment, home health and hospice care, skilled nursing facility, mental health, drug/alcohol rehabilitation, physical/occupational/speech therapy, acupuncture and chiropractor services.
  • Additional Services. Additional services may include dental care, vision, complementary and alternative care, access to 24 hour nurse call/help line, disease management services and/or weight loss or smoking cessation programs. While dental and vision care are very important, these may not be items you wish to include when selecting the policy for your insurance coverage.

If you are selecting the policy that is bare bones in order to save money, I would caution you to reconsider your thinking. This line of thinking is assuming that you will always remain in good health and, on the outside chance that something catastrophic happens (let's consider a little disaster like a ruptured appendix), you will be covered.

Meanwhile, you will dutifully put aside the money you would have paid for a more "expensive/comprehensive" policy into a savings account "just in case." The problem is, even if you managed to set some money aside, it will never be enough when disaster strikes.

The other more significant problem is, once "disaster" does strike, you will now have a pre-existing condition. Once you have a pre-existing condition, trying to qualify for a "good policy" can be very difficult and costly.

When you are selecting the policy, it is much better to purchase a good, comprehensive policy when you are "healthy", than to try to purchase the same policy once you have one "pre-existing" condition.

The last thing you should consider about buying a policy that only covers catastrophic events is that it becomes nothing more than a very expensive paper weight. If you are paying monthly premiums but you are not able to access any health care, then you are really throwing your money away.

How to Determine the True Cost of Your Policy

Selecting Your Providers - Narrowing Your Options

How to Select a Medical Insurance Company

What is NCQA and JCAHO?

Return to HOME from Selecting the Policy

There are many terms used in medical insurance policies. Use the Search Box below to find specific terms.

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