The Wall Street Journal had an interesting piece on deciphering your Health Insurance Plan. Read it for some interesting horror stories about people not understanding the terms of their plans.

The top 5 tips offered to help understand health insurance plans are as follows:

1) Start by making sure you have the full plan explanation, sometimes called the certificate of coverage, certificate of insurance or evidence of coverage. Though the document may be tough reading, the briefer summaries in marketing brochures can be “misleading,” says Mila Kofman, superintendent of the Maine bureau of insurance.

2) Closely check your out-of-pocket maximum, which represents the most you should have to pay for care in a given year. This important protection often comes with subtle qualifications.

3) Pay attention to the terms of your deductible.

4) Check how your plan handles doctors who don’t participate in your insurer’s network. Typically, plans that do provide out-of-network benefits pay only a percentage of so-called usual-and-customary fees. That can leave you with a significant charge.

5) Watch out for excluded benefits and coverage caps, including lifetime and annual limits on payouts. Some plans pay only a set fee per day of a hospital stay, for instance, which could leave you on the hook for thousands of dollars. Drug benefits don’t always include every medication. Some plans exclude maternity coverage, and some individual-market plans may not include care for pre-existing conditions. Insurers typically refuse to cover treatments they don’t consider “medically necessary.”

Understand Your Plan

Here are some helpful links for answers to frequently asked questions about health insurance:

• How much protection does health insurance offer and how can consumers know?
• Plan for Your Health
• Managing Medical Bills: Strategies for Navigating the Health Care System
• HealthCareCoach.com
• Questions and Answers About Health Insurance
• Health Insurance Glossary
  

  This entry was posted on Thursday, June 4th, 2009 at 4:05 pm and is filed under 21st Century Business, Benefits, Business, Healthcare, Risk Management. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.