Questions to Ask

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Review the following 'Questions To Ask' about health insurance so you're prepared to discuss this important health issue.

For all types of plans:

1. How much are the monthly premium, deductible, co-payment amount and cap? How does changing one amount affect the others?

2. What does the policy cover? Does it cover maternity, prescription drugs, out-of-hospital care, or home care? Are there limits on the number of days the insurance company will pay for these services?

3. What does the policy exclude?

4. Will the policy cover any medical conditions for which I'm currently being treated? Are there limitations or a waiting period involved in the coverage?

5. Is there a lifetime maximum cap the insurer will pay? This is important to know if you or someone in your family has a chronic or expensive illness or medical condition. Experts recommend that you choose a plan that has at least a $1 million maximum benefit.

6. What are the processes for getting emergency care? When does care need to be pre-approved? What are the rules for using urgent care facilities?

7. What preventive services, such as well-child visits, immunizations, mammograms, or checkups, are covered?

If the plan is an HMO or PPO:

1. Are there many health care professionals from which to choose? Are they located conveniently to where you live or work?

2. How difficult is it to change primary care physicians if you so desire? How often may you do this?

3. How are referrals to specialists handled?

4. What if you are out of town and need medical care?

5. What hospitals are available? Are they located conveniently to where you live or work?

6. How far in advance must routine visits be scheduled?

7. Is it possible to see a health care professional outside of the network? If so, how much will you have to pay?