Open Enrollment is Upon Us!

Horizons in Hemophilia, September 2010

By Michelle Fitzwater, Managed Care Contract Specialist

Open enrollment is the time to review your insurance needs.  Open enrollment happens only once a year; typically in October or November.  This is the time when you may enroll in or transfer to a different insurance plan offered by your employer.  Choosing the right plan is a really important decision and you may have to put in a lot of work to get a good result.  After all, once you choose a plan it will be your insurance for at least the next year.  In other words, you are stuck if you don’t like something about it.  Below is a checklist that will help you in evaluating your health insurance plan:

Does this plan cover factor?
Once you see that factor is covered determine if factor is covered on your drug card or the major medical plan.  Make sure HoG is an in-network provider in the plan.  If HoG is not in network, or you are not sure, please call me before you select a plan.

Does this plan include your primary care provider and your HTC?
Are your providers in-network with your plan?

What are the plan’s exclusions?
The policy may mention that it will cover “medically necessary” services and then exclude factor products.

What are the out-of-pocket costs?
Determine what your co-pay will be since these costs tend to change each year.  If coverage for factor is under Major Medical it will be subject to a deductible and out of pocket maximums.  If coverage is through a drug card, find out what “tier” it is in.  The tier determines your co-pay.

What is the annual deductible?
Some plans may require a deductible for each family member, so be aware.  You may end up paying double or triple the amount you first thought.

How much is the premium?
Premiums also change each year so be sure to ask about the premium cost.

If you don’t already know the answers to the above questions, direct them to your employer’s benefits manager or to someone in the Human Resources department.  They should have all the answers you need about the plans they offer.

If you need help in choosing a plan start by using the Health Care Comparison worksheet.  It will help you determine what plan will work better for your family.  Then contact me at the HoG office so I can help with any questions about coverage, or negotiate a contract on your behalf.