Health Plans


There are many different types of health benefit plans. Most employers offer healthcare coverage. You can find out more information about your company's plan by contacting your employer's human resource office, the health plan administrator or your union. The more information you have, the better informed your health care decisions will be.

Health care quality varies in this country—a lot.

Research shows that Americans want and value quality health care, which is a good thing. When you make health care choices that offer the best possible care, you are most likely to get the best possible results. Fortunately, more and more public and private groups are working on ways to measure and report on the quality of health care. This means that there is more and more information to help you make choices that improve the quality of your own care.

If you do have a choice of health care plans, consider the following:

Review the Benefits Available

Find out if the plans offered cover preventive care, well-baby care, vision or dental care. What are the deductibles? Knowing these facts will help you determine what your out-of-pocket costs will be. Matching your needs and those of your family will result in the best possible benefits. The least expensive may not always be the best.

The quality of health care services varies, but quality can be measured. You should consider the quality of health care in deciding among the health care plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your health care choices.

Your Plan's Summary Plan Description (SPD) Provides a Wealth of Information

Your health plan administrator should provide a copy. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits.

Assess your benefit coverage as your family status changes

Marriage, divorce, childbirth or adoption, or the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA).

Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. A special note: If your spouse's employer also offers a health benefits package, consider coordinating both plans for maximum coverage.

Plan for Retirement

Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer's human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage.

Take Charge of Improving Your Health Care

Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a health care organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible.

By Margaret Evans           


Related Links: