If your employer offers group health insurance as an employee benefit, it’s important to understand what the health insurance plan will and will not cover. While your employer ultimately decides what type of plans will be available, you’ll need to know which plan is best for you so that you make the right selection during the open enrollment period. You don’t have to be a health insurance agent or expert to understand what you’re selecting before you start paying your portion for coverage. Here are 6 things you should know about your company health plan so that you make an informed decision before enrolling.
1: What is the Difference Between an HMO and a PPO?
If you have the option to select either an HMO or PPO, you should know the difference. An HMO, also know as a Health Maintenance Organization plan, is a group plan where members will pay a flat fee for services given by doctors and clinics within the network. While members will pay a copayment for services, they typically aren’t required to pay a deductible. A PPO, also know as Preferred Provider Organization, is a plan that will contract doctors and institutions to pay a reduced rate for services. These plans typically cover most of the cost of treatment when you visit an in-network provider.
2: Which Providers Are in the Network?
If you already have a preferred physician or hospital, you should verify whether or not these service providers are covered under the plan. If none of the plans offered by your employer are covered, you may need to research new doctors before you commit to a plan.
3: How Much Will Your Copayment Be?
Your copayment is the amount of money you’ll be required to pay for each doctor or hospital visit. The typical office visit has a copay of between $10 and $50, and emergency or urgent care copays could be higher. Consider how often you visit the doctor, and how your lifestyle may affect your out-of-pocket expenses.
4: How Much is Your Annual Deductible?
An annual deductible is typically part of a PPO plan. This is the amount you must pay during the year before your health insurance will kick and start to pay for hospital visits and treatments. The higher your deductible, the lower your monthly premiums. Remember, if you’re injured at work, your employer’s workers compensation plan should pay for your treatment. If you’re forced to pay your deductible during this type of scenario, you may need to hire Workers Comp Lawyers Columbus to be compensated.
5: Are Prescriptions Covered?
You’ll typically have to pay a portion of the cost of your prescriptions, but depending on the plan you choose, the cost could be high. If you need regular medications, make sure to check and see how much your out-of-pocket expense would be for the medication and whether or not the insurer covers the medication.
6: Procedures for Referrals or Authorizations
When you have an HMO, you’ll need a referral to see a specialist. A PPO may offer more flexibility, but you may be forced to pay a percentage of your visit with a specialist. Check the authorization and referrals processes.
It’s important to review all of these factors before selecting any group health plan. Know your potential out-of-pocket expenses for the year and compare these to the premiums. Once you weigh the costs with the maximum out-of-pocket expenses, you can decide which plan is best for you.