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Shopping for North Carolina Health Insurance

Shopping for Health Insurance

Most people enroll in their health plan through an employer. When this is the case, your employer selects the insurance company or companies and decides which plan or plans will be available to you. Many employers that offer health insurance pay at least some of the premium for the employee, and some employers also pay part of the premium to cover dependents. Health benefits are a large expense for employers, so employers must choose between different types of plans and benefit levels. If your employer offers a choice of plans, you will want to want to choose your plan with care. Likewise, if you decide to purchase individual health insurance, it is important to select a product that meets your specific health care needs.

Where To Shop

As with any major purchase, it is recommended that you shop around to make sure you get the best value for your money. Many insurance companies and agents advertise in the yellow pages, newspapers, television and/or radio. In addition, the Internet can be a valuable tool for researching specific companies and products, and in some cases obtaining preliminary quotes. Insurance agents must be licensed to sell insurance in North Carolina. Choose one with whom you feel comfortable and who will answer your questions. To verify that an agent is licensed, contact the North Carolina Department of Insurance, Agent Services Division at (919) 807-6800. Similarly, insurance companies must be licensed to conduct business in North Carolina. To verify that a company is properly licensed, you may contact the Consumer Services Division at (919) 807-6750 or 1-800-546-5664.

Seek Unbiased Information

The North Carolina Department of Insurance does not rate or recommend insurance companies, but can provide the date a company was licensed in North Carolina, as well as general information on the company's complaint history. Additional information is available to consumers through a variety of other sources, including the Internet, consumer magazines and publications, public libraries, consumer groups, etc. An insurance company's financial strength is very important. Independent rating organizations such as A.M. Best, Standard & Poor's, and Moody's Investors Service publish financial ratings. Consider checking at least some of these resources to evaluate a company's strength; they can be found in most public libraries, by asking your agent, or on the Web.

Choosing A Plan

Aside from the type of plan and benefits covered, there are some other factors you may need to consider when choosing a health plan. The following items should be carefully considered.

Premiums

The premium is the amount paid for the insurance policy. Health insurance premiums can vary greatly, depending on applicant age and health history, the type of plan, the range of services covered by the plan, the plan deductible, lifetime maximum, and other factors.

Other Out-of-Pocket Expenses

In addition to monthly premium payments, most health plans require you to pay a portion of covered expenses, such as deductibles, coinsurance, copayments and excess charges when a provider's charges are higher than the plan's allowed amount. The out-of-pocket expenses for which you will be responsible should be considered along with the premiums when shopping for a plan.

Selecting the Right Managed Care Plan

If you have the option of choosing between two or more plans, you should carefully compare the differences. Aside from the obvious differences in covered benefits, benefit levels (how much the plan pays) and premiums, you should also consider factors such as each plan's provider network, pre-authorization requirements, access to specialist care, etc. Many health insurance companies place their provider directory on their company Website so you can check on whether your providers participate in an insurance company's network.

In addition, before selecting a plan, review the plan summary carefully, call the plan for information, and (if possible) talk with coworkers and friends about their experiences with the plan you are about to select. Health plans are required by law to honor your request for a copy of the policy or evidence of coverage BEFORE you enroll. Information concerning coverage criteria for specific conditions, information on prescription drug formularies and coverage of experimental procedures is also available at your request.

Questions To Ask When Shopping For A Plan

What services does the plan cover? What is not covered?
Will the plan cover preventative care, immunizations, well-baby care, substance abuse, organ transplants, vision care, dental care, infertility treatment, durable medical equipment or chiropractic care?
Will the plan pay for prescriptions?
Does the plan provide mental health benefits?
Will the plan pay for long-term physical therapy?
Do rates increase as you age?
How often can rates be changed?
How much do you have to pay when you receive health care services?
Are there any limits on how much you are personally required to pay for health care services you receive?
Are there any limits on the number of times you may receive a service?
What are the restrictions on the use of providers or services under the plan?
Does the health plan require you to see a provider in its network?
Are the network providers conveniently located?
Is the doctor you want to see in the network and accepting new patients?
What do you have to do to see a specialist?
How easy is it to get an appointment when you need one?
Has the company had an unusually high number of consumer complaints?
When calling the insurance company, how long does it take to reach a real person?

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