Health Plan Rules
There are general rules or guidelines that one must be aware of for. This will enable you solve an issue relating to your policy.
These rules concern a number of aspects;
(a) Provider: Your policy may indicate the health service provider that you are supposed to visit. These are commonly referred to as plan's network. An insurance company can refuse to cover any medical costs incurred after visiting a health care provider that is outside their network. You should read you policy carefully to understand if this may turn out to be the case or get clear clarification from the insurer.
(b) Specialists: A number of insurance companies do not pay for visits to a specialist unless you personal physician or a physician within their network recommends so. This calls for the need to get a referral first. Check what the policy says about this.
(c) Expensive services: Some insurance companies have made it mandatory for an insured to seek their authorization in addition to a referral before seeking expensive treatment such as surgery. You should find out if this is the case in your policy.
(d) Prescription drugs: Several insurance companies have a set drug list that they approve. It is very important to make your personal physician aware of this fact so that he/she does not prescribe drugs that are not on the list.
(e) Available benefits: It is not good to just have health insurance when you do not know the benefits you will derive from it. Critically read the policy and see if it covers preventive care, well baby, vision or dental care. Have your personal needs and those of your immediate family in mind. Try and avoid a situation where you are called upon to settle medical bills out of your pocket because you thought that all is covered by the insurance company.
(f) Status change: You may have taken out your policy before you got married or before you had children. Look what the policy says about this. Any change in your status automatically has a bearing on the cover. Make sure that you update you policy as such situations change. Policies have room for change but if yours does not have such a room, contact your insurance company and let them be aware of the change and let them make adjustments as appropriate.
(g) Job change: You may have taken insurance through your employer and you change your employer. Check the policy and find out what happens in such a scenario. You may switch to job that has limited insurance cover and dependants may be excluded. This may require you to take another policy to cover for the left out risks.
(h) Wellness programs: Most employers are developing programs that encourage their employees to have exercises and avoid risky life styles like smoking and excessive alcohol intake. You may find out that living a safe life style leads to lower premium quotes.
(i) Complaints: Read the policy and understand what dispute resolution mechanisms are there and how to lodge a complaint if any arises. This requires you to keep all correspondent received from the insurance company.
(j) Retirement: What happens after retirement? What health benefits will you, your spouse or dependants continue to have after your retirement? These are very important questions you should endeavor to find answers to as retirement can completely change your life.