Building Better Benefits Together since 1997


How to evaluate plan options ?


What can I afford?

It is important to consider factors like monthly premiums, annual deductible, co-payments and out-of-pocket maximums when evaluating your plan options. You should also look into options for saving and paying for health care, such as health savings accounts, health reimbursement accounts and flexible spending accounts.

Monthly premium

Lower monthly premiums can save you money, but they could mean you'll have a higher deductible and higher co-payments or co-insurance. Higher premiums cost more each month, but may provide more coverage to reduce your out-of-pocket costs.

Deductible

Deductible is the set amount you pay for covered health care services before your health insurance contributes to your costs. Higher deductibles generally lower your monthly premiums.

Co-payment amounts

Some plans require co-payments for every doctor visit. Others cover 100 percent of certain types of care, such as annual check-ups, but require a co-payment for other visits, such as treatment for illness or injury.

Out-of-pocket maximum

Out-of-pocket maximum refers to the maximum amount of money you pay out of your own pocket for covered health care services. After you reach that amount, your health plan pays 100% of eligible health care costs.

Health account options

Health accounts offer another option for paying for, and in some cases saving for, health care costs. A Health Savings Account, which must be paired with a qualified high-deductible health plan, allows you to put away a limited amount of pre-tax dollars to pay for eligible current and future medical expenses. An HSA is yours to keep even if you change employers or benefits. 

Coverage and benefits

Preventive care, such as annual check-ups and routine screenings like mammograms and colonoscopies, can help you stay healthy. Early detection of common conditions may lower your overall medical costs. Check to see which services are provided at what cost by your health plan.

It's also a good idea to try to assess what medical services you and your family might need in the next year. Consider a few questions as you evaluate your options:

  • Do you or your family members see a specialist to manage a chronic condition? 
  • Do you anticipate needing major surgery? 
  • Do you or your family members take any prescriptions regularly? 
  • Do you need additional coverage for vision or dental care? 
  • Are you planning a pregnancy?

Access to doctors and hospitals

It's important to understand your plan's requirements when it comes to doctors, hospitals and other health care professionals. For example:

Networks. Some plans require you to use doctors and facilities in their network of providers. Others let you go outside of the network for care, but may not cover the costs at the same level. 

Primary Care Doctor. Some plans require you to choose a primary care doctor who is responsible for managing your care and providing referrals for specialists when necessary. If a referral is required, your choices for specialty care physicians may be limited. 

Health and wellness resources

Many plans have tools like personal health records, cost calculators, health screening questionnaires and online coaching programs to help you get and stay healthy. Review plan options and take these into consideration when choosing your plan.

Exclusions and limitations

Read the fine print carefully when reviewing plan options to make sure you're aware of what might not be covered. Common exclusions and limitations include:

  • Elective or cosmetic surgery 
  • Alternative therapies 

In addition, separate insurance is typically required for things like vision care and dental coverage.