Amongst the first benefits a person considers when looking at a health plan (besides rates) are:
- What is my office visit co-pay?
- What are my prescription co-pays?
- What is my deductible?
These are all good things to know, but not the true measure of the insurance policy. Your insurance policy should not be chosen based on how it covers the routine expenses, but on how it covers the major expenses. After all, most of us can find a way to cover a doctor visit or prescription if we had to, but would not want to think about paying for a hospital stay. Always look at the maximum out of pocket expense to get a better idea of your potential expense. Insurance was not intended to pay all your expenses, it was originally designed to keep you from a catastrophic financial loss. The insurance industry is diligently working on getting back to this original concept.
Another important feature of any policy is the limitations and exclusions. As important as it is to know what your policy covers, it is equally important to know what it does not cover. Buried in the back of most benefit booklets, the Limitation and Exclusion section typically list off the benefits, procedures, treatments, etc. that are not covered. It also list benefits that are covered, but limited by either number of covered days or a maximum dollar amount. As an example, one insurance carrier (we do not sell) limits the amount they will pay for chemo drugs to a specific dollar amount per treatment. So if you are the insured and have been diagnosed with cancer and are beginning chemotherapy, you can expect that you will quickly reach this limit. This makes you responsible for all charges in excess of the dollar limitation. There can also be limitations on the dollar amount paid for a hospital stay or for surgeon fees. This makes you responsible for any fee in excess of this limitation. The limitations and exclusions are an important part of your policy and need to be considered when choosing a plan.
As your agents, it is our job to make sure you fully understand the policy you are buying. We also want you to understand why we choose to not represent specific carriers. If it is time for your renewal, and you have questions about an insurance carrier not on your spreadsheet, please ask. We would be happy to explain why they are not being quoted for your business.