| |
 |
Tipsheets
Finding a Health Plan and
Policy
Researching, comparing, budgeting and selecting a
health insurance plan(s) may seem overwhelming
and complex. These steps can help guide you through the process.
- Identify at least three health insurers to contact.
- Go to Alabama Health
Plans to get your research started.
- Are there purchasing alliances or
professional/trade associations in your community that offer a range of health
plan products to member employers?
- When researching potential health insurers,
consider evaluating:
- Financial stability
- Ease of administration
- Overall quality of services and reputation
- Be sure to look into the insurer's reputation
and rating for the quality of care provided under the health plan. You may want
to visit the The National
Center for Quality Assurance web site which publishes annual report cards
on health plans.
- Does the insurer make it easy for employees to:
- Find health care provider information (Are
online or hard copy directories easily available?)
- Resolve claims quickly and efficiently
- Access customer service representatives to
answer questions and resolve member service issues
- Once you have identified your health insurers,
review at least two or three different health plan options that each insurer
offers.
- When evaluating health plan options, consider these
questions:
- What overall health plan benefits would you be
receiving for the cost? Consider:
- Structure of the pharmacy benefit for
prescription drug coverage
- Hospitalization
- Behavioral or mental health coverage
- Choice of health care providers, hospitals and
medical groups that employees can easily access
You can use the Choosing A Health Plan Checklist to identify many
benefits and services that a health plan option can cover.
- What are the employer and employee costs?
- What are the monthly costs for the employer and
employee?
- How much are the participant's co-payments at
time of medical service?
- What is the out-of-pocket maximum that a
participant can reach before the health plan waives additional out-of-pocket
charges for the participant for the remainder of the year?
- Are there any cost-saving strategies to consider?
- What is the effective date of coverage?
- Most employers start their health plan coverage
on the first day of the month.
E. What is the health plan's cycle?
- Most health plans operate on a
January–December cycle but it’s good to double-check its 12-month
cycle.
F. What are rules of coverage and options?
- Health plan rules and options can be complex so
spend the time to understand and question them with the health insurer.
5. Once you have decided on a health insurer and a
health plan(s), you will want to:
- Give your company at least six weeks before the
coverage goes into effect so you can complete all the paperwork and
administrative steps.
- Sign the contract before the quote expires. Quotes
usually expire in 30 days
Back to top
|
