Merritt Personal Lines Manual: Plan Benefits
In addition to basic benefits, you might want to find out if the health plan you are considering covers:
- physical exams and health screenings;
- care by specialists;
- hospitalization and emergency care;
- prescription drugs;
- vision care; and
- dental services.
The Department of Health and Human Services Agency for Health Care Policy and Research (AHCPR) also recommends looking into how a plan handles the following:
- care and counseling for mental health;
- services for drug and alcohol abuse;
- obstetrical-gynecological care and family planning services;
- care for chronic (long-term) diseases, conditions or disabilities;
- physical therapy and other rehabilitative care;
- home health, nursing home and hospice care;
- chiropractic or alternative health care, such as acupuncture; and
- experimental treatments.
If health education and preventive care benefits are important to you, you might want to ask about services such as, shots for children, breast exams, Pap smears or programs to help quit smoking.
When comparing coverage, it is vital to look into a plan's limitations, exclusions and reductions to determine which expenses are not covered.
For instance, many policies will pay only for treatment that is deemed "medically necessary" to restore you to good health. These policies often will not cover routine physical examinations or plastic surgery for cosmetic purposes. Additionally, some plans limit or won't pay for programs for chronic disease or various medicines or equipment.
Indemnity and managed care plans typically won't cover treatments that are experimental. In this case, you would want to find out how the plan decides what is or is not experimental as well as your options if you disagree with a plan's decision on coverage.
