You have just been offered a new job. You ask about the salary, the probation period, and vacation time. The human resources representative mentions there is also a health insurance plan, but you are young and healthy, and it doesn’t seem nearly as important as the other benefits. Aren’t most health plans fairly alike any way?
Actually, no. Health plans are quite variable. As someone prominent said quite recently, “Who knew health insurance was so complex?” You may not have much choice about which health plan your employer offers, but you do have a need to understand what it covers.
To become knowledgeable, request a copy of the actual plan, not just a summary sheet. Look especially for restrictions. Can you go to any doctor you choose or do have to use one in a specific network in order for the fees to be covered? How about labs? Will any lab do for blood work or must you use a certain one?
Do you need a referral before you see that specialist such as your dermatologist or gynecologist? Do you have a co-pay every time you see a health care professional? Can you use a local pharmacy, or must you order your prescriptions from an online pharmacy?
What is actually covered? Will the plan pay for flu shots, for contraceptives, or for an annual physical or wellness visit? Do you have dental or vision coverage? If so, how often can you change your glasses or contacts? What about pregnancy if having children is in your future?
Is being treated in a hospital emergency room for a sprained ankle covered or must you be treated at an emergency center elsewhere? What happens if you have an accident and need surgery? Is there a co-pay for the surgery? Is there a maximum amount your insurance covers each year? What happens if you reach that cap?
The next area to explore is the type of plan and what options there might be for family members. Do they include domestic partners? If married, can your spouse be covered if he or she becomes unemployed? What does the family plan cost in comparison to the individual plan?
Finally, if your position were eliminated, what would it cost for you to continue your insurance coverage until you found another job (called COBRA). You will be required to pay the entire cost of your policy, not just the employee portion. This often amounts to $1000+ per month for your individual coverage. Family plans are much higher.
Your human resources representative should be able to answer most of your questions. There also should be a number to call to talk to someone from the insurance plan itself if needed.
This week is National Women’s Health Week. Use it as an impetus to learn and understand your health care plan and your options. Women have often been second class citizens when it comes to health care coverage. Be certain you know and use all of the health care rights you are entitled to in your health insurance. If certain benefits or options are missing, lobby your employer so that they can be included the next time the plan is negotiated. You may not feel you need to worry about health care now, but you never know when the unexpected will occur.