There is no doubt that choosing a healthcare insurance plan has the potential to be very confusing and finding the right one can certainly be a challenge.
You need to ensure that the plan you eventually choose is as good a match for your needs as possible, and one of the best ways of achieving this aim is to go through a process of elimination using your checklist of priorities so that you end up with a viable shortlist of potential plans.
From checking what the Ontario health coverage details are to confirming which type of health plan is most suitable it is important to get everything right, especially when you consider that it is your health and wellbeing that you are talking about.
Here are is a look at some of the key points you need to consider when selecting a suitable policy.
Not all health plans are the same
A good starting point in your search for a suitable policy is to understand that there are three distinct types of health plans and your first task will be to eliminate those that are not suitable so that you know which type of plan seems to tick most of your boxes.
If you choose a Health Maintenance Organization plan (HMO), for example, you need to be fully aware that you will have to use a pre-approved provider that is recognized within this network.
If there is not an approved provider within close proximity to you or the people who will be covered by the policy this would be a negative factor and, therefore, an HMO might not be suitable under those circumstances.
The next type of health plan to talk about is a preferred provider plan (PPP) which also offers you access to a network of suitable providers but the key difference between a PPP and an HMO is that this type of policy will permit you to use providers who are not in the usual network list.
It might be the case that you may not get the same benefits when you go to an out-of-network provider but if you like the flexibility of having this option it could be that a PPP is a way to go.
The other major type of health insurance plans is commonly referred to as a major medical or an indemnity plan.
What you get with one of these types of plan is coverage that extends to any licensed health provider.
Work out exactly how you intend to use your healthcare insurance policy
Once you have determined which type of insurance policy is likely to be the most suitable for you the next step will include conducting an honest appraisal of how you believe you and your family are most likely to use the services available with the plan.
If you primarily intend to make use of preventative care services it might well be that a plan that keeps premiums low by charging a higher deductible could be a smart move.
However, if you or someone in your family already suffers from some sort of medical condition that might need regular care and attention it could turn out that a plan that has no deductible could be a better fit for you.
What you tend to find us that in place of this deductible you might be offered a scenario where the alternative is a fixed dollar payment for each service provided.
You need to try and take an educated guess about whether it is likely that you will end up using your policy to deal with a medical condition or if it is a more plausible scenario that you will only end up using your policy to deal with preventative medical needs and are happy to pay a higher deductible.
It is important to know what is not covered too
Your focus will clearly be on what sort of key benefits your insurance policy will provide once it is in force but it should also be noted that it is a good idea to not only know your potential benefits but what exclusions are being imposed.
You can only be truly confident that you know exactly what your plan covers when you are fully informed on your benefits and your exclusions.
If the plan is being offered through your employer it might be the case that you need to ask them for a copy of the policy or at least a certificate of coverage that helps provide that key information.
The certificate should list all of the services that your insurer is prepared to cover under the plan and it should detail very clearly whether there are any limitations or services that are not covered.
With limitations, you will often find that the insurer is prepared o offer coverage to a certain level but once you exceed that maximum payout level you will be on your own and will have to fund the difference.
Read the details on how to access the services being offered
Another thing that the plan certificate will outline is how you can make a claim and access the benefits and services that you have coverage for.
Every policy will lay out a clear set of procedures that you will have to adhere to and follow if your claim is going to be validated with the minimum of fuss.
If you don’t follow these procedures or don’t get the right authorization before accessing medical services you could find that your insurer decides to decline your request for assistance.
If you are not sure exactly how to access the services you need it is far better to ask than assume and even if you find yourself dealing with a medical emergency it would be a good idea to have prior knowledge of what you need to do to get treatment via your health plan.
If you take the time to consider all these points and are happy with the terms and conditions as well as the claim procedures outlined, you should be able to sign with a degree of confidence, secure in the knowledge that you have the type and level of coverage you need.