| Q: What is open enrollment and why is it important? |
A: Typically, employers set aside an open enrollment window for employees to review, compare and choose from the health plans offered by the company. In most cases, open enrollment comes once a year, so it''s important to take advantage of this time period to comparison-shop and ask your benefits administrator about specific questions you may have about coverage. Separately, life-changing events – like the birth of a child or loss of a loved one – may qualify you to make changes outside of the open enrollment window. Learn more about changing your health insurance coverage.
Q: Will I have to select a new doctor during open enrollment? And what if my employer has switched insurance carriers?
A: During open enrollment, you can compare health plans and make changes to your coverage. If you stay with your current health insurance carrier, it''s not likely that you''ll be required to select new physicians – unless your provider is dropped from the plan''s network, retires, etc. Should you elect a new health insurance carrier – or your employer discontinues its previous plan – you may have to do some research. In any case, you''ll want to double-check whether your physician falls in the plan''s provider network. Follow these pointers in choosing a doctor.
Q: What should I look for in a plan?
A: Good question. A health insurance plan generally offers coverage for a mix of health care services ranging from traditional medical (e.g., office visits and hospital/emergency room treatment) and preventive care to rehabilitation and alternative or complementary medicine. The key is knowing the total amount you can expect to spend for care. A health insurance broker may be able to offer money-saving tips.
Q: How do I evaluate prescription drug coverage? How do I find out if a particular prescription is covered?
A: It''s important to understand your insurer''s prescription drug benefits before you purchase your medication. You may pay by using in-network pharmacies, asking for generic drugs or using mail-order services that deliver to your door. Keep these prescription drug facts in mind.
Q: Are dental benefits included in my coverage?
A: Don''t assume that your health insurance includes dental, vision, mental health or other services at the same level – or at all – until you review the fine print in your health plan. If your coverage does not look adequate for your family''s needs, you may need to consider supplemental insurance. A supplemental health plan may offer you some limited benefits to complement your primary plan.
Q: What are deductibles and co-pays? How do they work?
A: Health insurance deductibles and co-pays are out-of-pocket expenses for which you''re generally responsible. For a listing of common expenses, review our health expense chart. You can, however, take steps to limit your costs with a tax-free account for future expenses.
Q: I have a pre-existing condition. Can I get insurance coverage? How will my pre-existing conditions impact my policy and rates?
A: As you apply for health insurance – even an employer''s group plan – keep in mind that pre-existing conditions may lead to higher premiums and, in some states, denial of coverage. Here''s what you need to know about pre-existing conditions and insurance premiums.
Q: Will my doctor accept this plan? How do I make sure my doctor is in a specific insurance plan''s network? What does it mean to be in-network or out-of-network?
A: An out-of-network provider is not in your insurance company''s preferred network. You may be required to pay your physician at the time of service and file a claim with your insurance company separately for reimbursement. In the end, consumers typically pay more for out-of-network services. Consult with your benefits administrator, review your plan''s provider network booklet or website, or double-check with your provider for network status. If your plan has changed and you''re shopping for a provider, search by specialty, condition, treatment or procedure.
Q: How do I know if a particular service or procedure is covered by my insurance?
A: Your benefits administrator or insurance carrier should be able to give you a complete breakdown of coverage for office visits, diagnostics and testing, emergency care and a host of other services. Not satisfied with your plan? Get a health insurance quote from another carrier or consult with a health insurance broker to find the best health insurance plan for your needs.
Q: What is COBRA?
A: COBRA is a law that may offer you some protections – and extend your health care coverage – if you lose your job or a spouse''s health insurance benefits. Find out about COBRA qualifications and costs.