Choosing an Appropriate Health Insurance Policy

As an individual, whether the person is eligible for group insurance or an individual plan, he/she should carefully compare costs and coverage between various health insurance products and services being offered in the US markets.

As an individual, make sure to compare the following points:

Premiums.
Coverage/benefits.
Access to doctors, hospitals and other healthcare providers
Access to after-hours and emergency care
Out-of-pocket costs (co-insurance, co-pays, and deductibles) and Hidden Expenses.
Exclusionsand limitations

Even if the individual does not get the option to choose his/her health plan such as offers only one health plan offered by the employer—the concerned employee will still need to understand and comprehend the coverage provided under the healthcare insurance policy being offered.

The following points needs to be analyzed by the employee:

What kind of healthcare services is being covered by the plan?
What are the medical benefits required by the individual and his/her family members?
When does an individual require prior approval to ensure coverage for the medical care (for example, elective hospitalization for scheduled surgery)?
How are benefits paid? Is it required by the individual to submit the claim?

It is advisable and imperative to understand how his/her healthcare plan works. It is always recommended not to wait until he/she requires emergency treatment to ask relevant questions.

Incase, if an individual has the option of choosing between Indemnity and Managed Care Plans, it should always be remembered that they may differ in several ways as enlisted below:

How does an individual access Healthcare Products/Services?
How does an individual obtain specialty care?
How much is required to pay for availing Healthcare facilities? What is the mode for making the payments for availing the healthcare facilities?

Despite the differences, both - Indemnity and Managed Care Plans share some common features. For example, both types of plans cover a wide array of medical, surgical and hospital services. Most plans offer some coverage for prescription drugs. Some plans also have at least partial coverage for dentists, alternative medical professionals and other healthcare providers. The major difference between indemnity (non-network based coverage) and managed care plans (network-based coverage) is regarding the choice of doctors, hospitals, and other healthcare providers; out-of-pocket expenses for covered services and the mode of payment for the medical bills. It is always recommended to have an eye and keep a check on the physicians and hospitals that are incorporated in the plan.