Insurance Changes this Year Require Study

With one HMO leaving the market, another expanding its provider network, and new wellness initiatives in the plans; state employees should carefully examine their opportunities during option period this year.

“Even if you are pleased with your choices in the past, new plan opportunities could save your family money,” said OPEA Policy Director Trish Frazier.

State employees should “put a pencil” to insurance options this year and consider all plans available in your area.

Don’t just choose the plan with the lower premium, co-pays and deductibles could make plans with lower premiums not as inexpensive as other options.

A plan with higher premiums and lower out-of-pocket costs may not be the best for your family if you rarely use your insurance.

Depending on your income and the amount you spend on health care, the high deductible plan may be an option for your family. If you establish a health savings account, you can accumulate funds from year to year?

Just because a plan is available in your area does not mean a doctor of your choosing accepts that plan. Be certain to see if the doctor of your choice is in the network. If you will be a new patient, be certain the provider is accepting new patients on the plan. Also, be sure your area hospital and clinics are on the plan.

If you anticipate a procedure or hospitalization or have an expensive condition, remember to look into the plan’s out-of-pocket maximum.

If you are on medications, check the co-pay for your prescriptions.

Use some of your “explanation of benefits” (EOBs) reports from your insurance plan to compare what other plans would have paid.

Be certain to consider health and wellness opportunities with each plan. What preventive visits and tests are paid by the plan? What incentives are available?

Examine your dental and vision providers, also. How much is provided toward glasses and contacts?

What is the maximum paid per year on the dental plan? Are there dentists in the area are in the network? Do you anticipate needing an endodontist or orthodontist in the near future? Are there network providers in the area for these specialties? Are they accepting new patients?

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