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Are all the benefits you need part of the plan?
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Are mental health services covered?
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Are pre-existing conditions covered?
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Are supplies covered?
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Are there dollar limits?
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Are there providers in your home area?
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Are you allowed to see a provider outside the plan?
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Are you talking to an agent, or directly to the insurance company?
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Are your prescriptions in the insurance company’s formulary? What are the co-pays for each?
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As you research the providers, keep records of your questions, conversations, dates, times and who you spoke to.
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Ask other people you know for referrals.
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Be wary of a company that gives a long list of covered expenses. It is much better to go with a company that tells you what is not covered.
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Can the doctors treat you over the phone, when appropriate?
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Can you set up coverage over the phone? Or is a face-to-face appointment required?
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Carefully research your specific medical conditions. Are they covered by the plan?
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Carefully study the summary plan description.
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Check out the insurance company web sites to learn more about their plans
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Does the company have a solid reputation?
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Does the plan pay for substance abuse?
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Does the policy include dental insurance?
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Does your Primary Care Physician treat patients from more than one insurance plan?
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Estimate what your out-of-pocket expenses will be. Compare for each plan.
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Get all information in writing if at all possible.
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How are claims filed?
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How are lab tests covered? Where will you have to go to have lab work done?
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How convenient is the location of the emergency room, hospital, pharmacy, lab and physicians to your home or work?
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How is emergency care handled?
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How long does it take to pay claims?
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How many doctors can you choose from?
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How much is the monthly premium?
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If I have questions before submitting my application, who do I call?
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If you are admitted to the hospital, what hospitals are covered?
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Is preventative care covered by the plan?
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Is renewal of the coverage guaranteed?
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Is the plan a PPO, HMO, POS, EPO or Indemnity Plan? Is it a Catastrophic or HSA plan?
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Is there a deductible? Individual? Family?
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Is there a mail-order service available for prescriptions? Do I save money by using it? Is it required to use?
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Is there a member booklet that explains the plan details? Can you see it before signing up?
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Is there an appeal process?
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Is there coverage for chiropractic care? Physical therapy?
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Is there coverage for infertility treatments?
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Is there maternity insurance?
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Is there online access to my policy, claims, payments, premiums?
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Is this a full coverage plan?
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Make a list of the various insurance companies available to you, and compare features
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Review the list of providers, are the doctors you want on the list?
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What about travel out of the country?
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What are the limits to medical tests?
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What hospital emergency rooms does it cover?
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What if I want to switch primary care providers (PCP)?
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What if you are late on a premium payment?
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What if you have a child that away at college? Adult children that you are supporting?
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What if you have another medical insurance plan? Which one is primary? Can they work together?
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What is covered?
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What is excluded?
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What is the company’s rating?
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What is the co-pays or co-insurance for each visit, prescription, procedure?
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What is the cost for each procedure?
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What is the coverage for ambulance trips?
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What is the coverage for vision? Eye exam? Glasses? Contacts?
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What is the out-of-pocket maximum?
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What is the process for applying for coverage?
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What is the process for seeing a specialist? Do you need a referral?
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What limitations does the plan have?
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What methods of payment do they accept for your premiums?
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When will coverage take effect?
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Where can I purchase my prescriptions?
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Which doctors are accepting new patients?
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Who is covered by the plan?
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Will I be able to get the prescriptions that my doctor feels is best for me?
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Will your plan cover you if your travel?
