Act requires health insurance companies to spell out coverage
Just in time for open-enrollment season, a new rule requires health insurance companies to give you a new form that spells out what coverage they provide.
The idea is to make it easier for you to compare plans.
Most of us would rather have root canal than read the paperwork that comes with our health insurance plan. Now this process is a bit less painful, thanks to the new Health Care Reform Act.
All private health insurance companies are now required to provide a "summary of benefits and coverage." The eight-page form highlights what the policy covers and how much specific benefits cost.
Because every company must use the same format to provide this information, it should be much easier to comparison shop, whether you are buying coverage on your own or choosing a plan at work.
Even if you aren't choosing between plans, it's important to know how you are protected. The new form uses a question and answer format to accomplish that, such as:
- What is the overall deductible?
- Are there other deductibles for specific services?
- Is there an out-of-pocket limit on my expenses?
- Is there an overall annual limit on what the plan pays?
- Does this plan use a network of providers?
- Do I need a referral to see a specialist?
- Are there services this plan does not cover?
If you don't know the answers to these questions, you could make decisions that are not in your best interest and wind up paying more than expected for medical care out of your own pocket.
The new summary of benefits form includes an extensive list of common medical events such as a hospital stay, outpatient
surgery and prescription drug purchases, and what you'll pay if you use a preferred provider or an out-of-network provider.
Remember: as you compare policies - whether at work or on your own - you need to consider more than just the monthly premium. You need to know what's covered, what's not covered and how much you'll spend in deductibles and copayments because these days, a surprise medical bill can be devastating.
The idea is to make it easier for you to compare plans.
Most of us would rather have root canal than read the paperwork that comes with our health insurance plan. Now this process is a bit less painful, thanks to the new Health Care Reform Act.
All private health insurance companies are now required to provide a "summary of benefits and coverage." The eight-page form highlights what the policy covers and how much specific benefits cost.
Because every company must use the same format to provide this information, it should be much easier to comparison shop, whether you are buying coverage on your own or choosing a plan at work.
Even if you aren't choosing between plans, it's important to know how you are protected. The new form uses a question and answer format to accomplish that, such as:
- What is the overall deductible?
- Are there other deductibles for specific services?
- Is there an out-of-pocket limit on my expenses?
- Is there an overall annual limit on what the plan pays?
- Does this plan use a network of providers?
- Do I need a referral to see a specialist?
- Are there services this plan does not cover?
If you don't know the answers to these questions, you could make decisions that are not in your best interest and wind up paying more than expected for medical care out of your own pocket.
The new summary of benefits form includes an extensive list of common medical events such as a hospital stay, outpatient
surgery and prescription drug purchases, and what you'll pay if you use a preferred provider or an out-of-network provider.
Remember: as you compare policies - whether at work or on your own - you need to consider more than just the monthly premium. You need to know what's covered, what's not covered and how much you'll spend in deductibles and copayments because these days, a surprise medical bill can be devastating.
Thanks Herb! Might you have a list of health insurance companies in WA? Thanks, JP
 @j.p.:Â
You would be better off to go through an insutrance brokerage - they have access to multiple plans, and can help you find what is a good "fit" for you - rather than you (as an individual) having to contact multiple companies on yhour own & not necessarily knowing what to ask about.