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Did You Know? |
Roughly One-Half (51%) of Employees with Health Insurance work for a company that only offers one type of plan1
80% – The Increase in Family Coverage Premiums, up from $138 to $248 between 2000 and 20062
High-Deductible Health Plans (HDHP) cover an individual or family with a high annual out-of-pocket deductible, and offer a lower monthly premium
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Take Our Quiz |
1. A managed care plan:
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2. Which plan type requires you to choose a primary care physician (PCP) from an approved list and get referrals for specialists, and generally won’t pay if you go out-of-network?
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3. With a PPO
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You have health insurance, but do you also have the assurance that when you need it, you’ll be covered? This issue of Driver’s Seat aims to help you understand the basics of coverage and get a better handle on your health care costs. If your employer provides a choice, you can determine your potential annual expense by considering the four costs typically associated with a health plan: |
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Premium – the amount you pay for the plan, usually taken out of your paycheck at regular intervals (e.g., monthly) |
| Tip: |
For the lowest pharmacy copay, ask for generic drugs. |
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Copay – the fixed amount you pay for services when you visit the doctor, pharmacy or hospital |
| Tip: |
When you select an
in-network provider, charges are discounted, so your coinsurance applies to a smaller bill and you pay less. |
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Coinsurance – the percentage you pay for covered services after the deductible has been met. In an 80/20 plan, for example, the insurer pays 80 percent and you pay the remaining 20 percent |
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Deductible – the total amount you must pay for services before your insurance begins to pay (doesn’t include premium costs) |
| Tip: |
For the lowest pharmacy copay, ask for generic drugs. |
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Also consider your out-of-pocket (OOP) maximum, which is the most you’ll be responsible for in any plan year. |
| Tip: |
For the lowest pharmacy copay, ask for generic drugs. |
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Already picked your plan? Get familiar with the Summary Plan Description, a booklet you received when you signed up. |
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Details, Details … |
| Don’t be afraid to look at the fine print and ask questions. Here’re some other important things to think about: |
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Lifetime maximum – the amount the plan will pay on an illness or lifetime basis (e.g., $3 million), the higher the better |
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Stay in-network for your PCP and referrals, or your benefits could decrease and your costs increase. |
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Network and referrals – some plans require you to get permission (a referral) from your primary care physician (PCP, who is “in-network”) to see a specialist. If any of your providers are currently out-of-network, ask them to visit GreatWestHealthcare.com for information about joining our network |
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Exclusions, waiting period and pre-existing conditions – some plans may not cover your medical condition at all, or may require you to wait a specified time for coverage to begin for that pre-existing condition |
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For access to a form that’ll help clarify what your plan covers and “25 Benefit Questions to Ask About Each Health Plan,” visit ConsumerReports.org/health.3 |
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Knowing your current coverage and anticipating future needs is your best plan for ensuring adequate coverage. Go to MyGreatWest.com and use the Plan Cost Comparison Tool to get an estimate of your annual OOP costs. |
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Great-West Healthcare refers to products and services
provided by Great-West Life & Annuity Insurance
Company and its subsidiaries Alta Health & Life Insurance
Company and Great-West Healthcare HMO companies.
It also refers to New England Life Insurance Company’s
and Metropolitan Life Insurance Company’s group business
currently administered by Great-West. Great-West
Life & Annuity Insurance Company is not licensed to do
business in New York. Products are sold in New York by its
subsidiary First Great-West Life & Annuity
Insurance Company, White Plains, N.Y.
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