Discerning The Healthcare Benefits of Different Policies

Healthcare benefits are difficult to explain in a few pages. However, a benefits summary makes a good attempt at providing the necessary information on a given policy. Insurance companies provide benefits summaries to insured persons on an annual basis, typically. If you are shopping for insurance, you can access sample documents online or request them through the mail to compare different policies based on common criteria.

Who Is Insuring You?

The first thing you should consider when comparing healthcare benefits is the actual insurance company itself. You can locate reviews and ratings on nearly every major healthcare provider in the country. If your employer has chosen an insurer for you, you can speak with your manager or company owner regarding why this insurer was chosen, the relationship they have had with the insurer, and if there are other options for you. For example, if you are not happy with the company provided, some businesses will give you the chance to elect your own coverage and receive a flat reimbursement. 

What Is Covered?

A benefits summary from your insurance company explains what is covered in a simple grid. You will likely see the following rows: out-patient procedures, in-patient care, emergency room and supplies. You may also see rows for physical or mental therapy and other policy-specific provisions. For each row, you should see the in-network deductible, out-of-network deductible, in-network limits and out-of-network limits. You may also see a copay. You will likely see a per-occurrence and annual deductible. It can be overwhelming to determine what this means. However, when you hold two benefits summaries side-by-side, you should aim to pick the policy with the higher limits, lower deductibles and lower copay. Of course, you will have to decide if this "ideal" insurance is affordable based on the cost per month to you.

How Much Is Covered?

Often, an insurance policy will cover up to a certain amount of each individual claim. This is not usually set by a value limit but by a percentage limit. For example, a policy may cover 60% of an in-patient, in-network hospital visit. This means, no matter how much your bill is, your insurance company will pay 60% of that bill. You should compare policies based on this limit. It may be tempting to save money by opting for lower limits, but you should only do this if you can reasonably pay out-of-pocket for expensive claims. Ultimately, you are looking for a good balance of coverage and expense.

What Options Are There?

You will want healthcare benefits that give you options. This means having a lot of doctors in-network, having different choices for a PPO or HMO option, and flexibility with deductibles and limits. Since you are aiming for a balance in the coverage and affordability, you will be more likely to achieve that balance through electing options specific to your needs. For example, you may need high coverage for prescription medication due to a long-term medicine you take, but you may not need a low deductible if you can cover a lot of your other expenses yourself.

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