Congratulations on the job offer! Once salary negotiations have ended and you’re almost ready to sign on the dotted line, it will be time to delve into your new company’s health insurance plan. And while this task can seem baffling, knowing the important factors to consider about coverage can make all the difference. We’ve highlighted seven critical questions you’ll want to ask in order to choose the most suitable plan for your needs.
What type of health insurance plans are available at this company?
It’s imperative to understand if you are being offered an HMO, PPO, EPO or POS plan. A Health Maintenance Organization (HMO) plan tends to offer coverage from doctors and hospitals within a certain network for lower (“group”) rates and copayments. Aside from an emergency situation, it rarely covers any physicians and medical facilities that are out of network.
A Preferred Provider Organization (PPO) plan provides a larger network of doctors and hospitals while allowing its members to choose health care professionals and facilities that are out of network for an additional cost. Due to the flexibility within this plan, higher monthly premiums and copayments are usually part of the package.
Other options include an Exclusive Provider Organization (EPO) plan, which offers the flexibility of a PPO (i.e. no referrals necessary) but means you’ll have fewer physicians to choose from within the network. Also, if you receive care from a doctor or hospital not covered under the plan in a non-emergency situation, you’ll be responsible for the full cost. There’s also Point of Service (POS) plans, which require referrals from a primary care physician. While out-of-network services are an option, those visits will come at a higher price than seen in the PPO plans.
What will my out-of-pocket expenses be?
Along with figuring out the rates for your monthly premium and various copayments, it’s important to ask about other costs, such as deductibles—the amount of money you pay before your benefits take over a percentage of the cost—and the maximum for out-of-pocket expenses. You’ll also want to inquire about dental and vision coverage and emergency services, including laboratory tests, surgical treatments, x-rays and other types of scans.
Will members of my family be included on this plan?
Anyone interested in coverage for a spouse and/or child will want to look into the additional cost of each person that would be added to the plan. Keep in mind that a health insurance company that offers coverage to opposite-sex spouses must offer the same coverage to same-sex couples.
Will this plan cover prevention care and specific healthcare needs?
If you or anyone in your family has a pre-existing condition, you’ll want to find out if specific prescriptions, as well as routine appointments (including mental health services) will be covered. Also, ask about preventive health services, such as cancer screenings and immunizations. According to HealthCare.gov, the majority of plans must cover preventive health services at no cost.
Does this coverage restrict me to a particular area?
Some plans may only offer coverage within a certain state, which is a vital detail for people who travel domestically or internationally, or who live and work in different states. An HMO plan, for example, may require that you live or work within the network’s service area.
Is there a waiting period before the coverage begins?
Now that you may have zeroed in on the plan that agrees with your lifestyle (and wallet), it’s essential to inquire whether the company has an open enrollment period for new employers. If coverage will not begin for weeks—or months—after your starting date, you may want to consider looking into a short-term insurance plan, such as COBRA.
Can I review a summary of your health insurance plans?
It’s easy to become overwhelmed when comparing the pros and cons of various plans. An employee in the human resource department should be able to send you an outline that contains the basic details of each option. Also, it may be helpful to visit HealthCare.gov in order to understand the current health insurance laws.
