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Choosing a Health Plan

Millions of Americans are offered a choice of health plans through their employers, but the question is —What makes a good health care plan? Here are some things to consider when choosing a health plan.

Are you choosing a plan simply because it is the cheapest? This may not be the best way to go. Some inexpensive plans have a high deductible and no comprehensive coverage.
Is the plan accredited by the National Committee on Quality Assurance? This is a good indicator of quality.
Are your current doctors and specialists in the plan? If not, make sure you will be able to see a certain provider or specialist, such as a physical therapist, without too much added expense and difficulty.
Is physical therapy coverage adequate? If you should have an injury or illness requiring rehabilitation, you will need a plan that offers an unlimited number of visits to a physical therapist or that allows for the number of visits to be extended if needed.
Are there lifetime limits on benefits? If so, you could face a serious financial crisis if you or a covered member of your family suffers a major illness or injury.
Does the plan have an out-of-pocket maximum? In this case, once you have paid a certain amount (usually several thousand dollars) the plan would cover the rest.
How does the plan handle grievances and appeals? The procedure should be simple, timely, and accessible.
Does the plan permit use of outside doctors, specialists, or hospitals? Called "point-of-service" option, this would allow you to see a provider, such as a physical therapist, who is not in your plan. There may be an additional cost, but it may be worth it.
What is the plan's disenrollment rate? A high rate of members leaving the plan annually may indicate customer dissatisfaction.



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