1: What Type of Plan Is It?
Find out if it is an indemnity health plan or a managed care system. With indemnity health plans, also known as fee-for-service plans, you pay a percentage of the medical costs, and the insurance company pays the remaining percentage. Typically, you are allowed to choose your own doctors.
With managed care -- meaning either a health maintenance organization (HMO) or a preferred provider organization (PPO) -- you have minimal out-of-pocket expenses. With an HMO, you or your employer pays a fixed monthly fee for health-care services, but you can only go to a doctor who is under contract with the HMO. Through a PPO, you or your employer gets a discount if you use physicians within the plan. You may go to a doctor outside the PPO system, but you'll pay more.
2: How Much Will I Have to Pay for Medical Care?
Find out the amount of the premium. Next, ask whether you will be charged a co-payment, a small flat fee, perhaps $10, charged for health care services.
Some plans have a deductible instead, an amount that you have to pay before the policy starts to cover any medical costs. Find out about this, and find out the percentage of costs that will be covered by the plan once you've met the deductible.
3: Will I Be Able to Use My Current Doctors?
Ask about any limits on choosing your doctors or hospitals. Ask for a list of the doctors and hospitals that are covered to decide if the plan is right for you.
4: What Benefits Are Included?
Ask what benefits are not covered by the plan, too.
5: Are Routine Examinations Covered?
Ask about mammograms, pap tests, immunizations and other routine check-ups.