Why do you need health insurance?

Today, health care costs are high, and getting higher. Who will pay your bills if you have a serious accident or a major illness? You buy health insurance for the same reason you buy other kinds of insurance, to protect yourself financially. With health insurance, you protect yourself and your family in case you need medical care that could be very expensive. You can't predict what your medical bills will be. In a good year, your costs may be low. But if you become ill, your bills could be very high. If you have insurance, many of your costs are covered by a third-party payer, not by you. A third-party payer can be an insurance company or, in some cases, it can be your employer.

What is the best health plan for me?

There is no one "best" plan, there are some plans that will be better than others for you and your family's health needs. Plans differ in how much you have to pay and how easy it is to get the services you need. Although no plan will pay for all the costs associated with your medical care, some plans will cover more than others.

With any health plan you will pay a basic premium, usually monthly, to buy the health insurance coverage. In addition, there are often other payments you must make. These payments will vary by plan but essentially are deductible and copayments.

Here's a list of key questions to consider in selecting the plan that best meets your needs:

• How much will it cost me on a monthly basis?
• Are there deductibles I must pay before the insurance begins to help cover my costs? After I have met the deductible, what part of my costs are paid by the plan?
• What doctors, hospitals, and other medical providers are part of the plan? Are there enough of the kinds of doctors I want to see?
• Where will I go for care? Are these places near where I work or live?
• If I use doctors outside a plan's network, how much more will I pay to get care?
• Are there any limits to how much I must pay in case of major illness? What about limits and deductibles for certain types of care such as surgery or maternity?

What types of health plans are available to me?

Health insurance plans usually are described as either indemnity (traditional) or managed care. Indemnity and managed care plans differ in their basic approach. Put broadly, the major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid. Usually, indemnity plans offer more choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers than managed care plans.

What is a provider?

A provider is a hospital, health care facility, physician or other medical professional that provides health care services.

What is a Primary Care Physician (PCP)?

A physician or other medical professional who serves as a group member's first contact with a plan's health care system. Also known as a primary care provider, personal care physician, or personal care provider.

A physician selected by the member, who is part of the plan network, who provides routine care and coordinates other specialized care. The PCP should be selected from the network that corresponds to the plan in which you are a member. The physician you choose as your PCP may be a family or general practitioner, internist or pediatrician.

What is a copayment?

A copayment is a fixed dollar amount or a percentage that you pay for each provider visit. For example, with some plans you may pay a fixed amount such as $5 or $10 per visit. Other plans will charge you a percentage of the total fee for the visit. So if your copayment is 10% and the doctor visit was $200, you would pay 10% which, in this case, would be $20.

What is a deductible?

A deductible is the amount of annual medical expenses that a health plan member must pay before the plan will begin to cover expenses. For example, if your plan has a $500 deductible, you will pay the first $500 of your medical expenses before your health plan begins paying the expenses. Only expenses for covered services apply towards the deductible. For example, if you paid $100 for a visit to a chiropractor but the plan does not consider chiropractic care a covered expense, then the $100 will not apply toward your annual deductible.

What is the difference between an in-network and an out-of-network medical provider?

An in-network medical provider is within the approved network of providers for a particular health plan. Out-of-network providers are not part of the approved plan network. If you visit a doctor within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network doctor. In many cases, the insurance company will not pay anything for services you receive from outside their network; however, there are exceptions to this.

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