Medical Insurance : What You Need to Know when Deciding

If you need to make a decision between several plans that your employer offers, or are looking to buy an individual health insurance policy, you need to know what to look for before making a decision.

When choosing a health plan, there are several important questions you should ask your human resources department (if it’s a group plan you’re considering) or health insurance agent. These are just some of the questions that will help you understand your choices and choose the plan that is best for you.

  • Does the plan cover you for the specific doctor or hospital that you would like to use?
  • Can you go to any hospital/clinic you like?
  • What is the maximum Room & Board are you entitled to?
  • Do you get a daily allowance when you are in the hospital to replace your income?
  • How does the referral (GP to Specialist or direct) system work with each plan?
  • What pre-existing conditions would affect coverage?
  • How will each plan handle care if you or a family member is away from home?
  • What are each plan’s monthly premium, deductible and coinsurance and would they fit within your budget?
  • Are there other fees, such as copayments and out-of-network fees?
  • Will the premiums increase over the years?
  • Is the plan GUARANTEED renewable no matter how much you claim?
  • Is there a Gurantee Letter system in place?
  • What is the claim/reimbursement procedure/process like?
  • Is there a maximum amount each plan will pay over a year or lifetime?
  • What types of benefits are specific to this plan?
  • How much on average does the proposed insurer pay in medical claims every month?
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