HEALTH INSURANCE PLANS

Essentially, there are two kinds of heath insurance, "Fee-for-Service" and "Managed Care". Although these plans differ, they both cover an array of medical, surgical, and hospital expenses. Most cover prescription drugs and some also offer dental coverage as well.

Gold Cross Medical Group strongly endorses managed care health insurance.

When given the opportunity to choose a health insurance plan through your employer, or when purchasing your own medical coverage, it is critical that you determine the best options to suit your needs and the needs of your family.

Call Gold Cross Medical Group for personalized consulting that can answer many of your questions and take the mystery out of choosing the right health care plan. For instance:

1. How affordable is the cost of care?

• What is the monthly premium I will have to pay?
• Should I try to insure most of my medical expenses or just the large ones?
• What deductibles will I have to pay out-of-pocket before insurance starts to reimburse me?
• After I’ve met my deductible, what percentage of my medical expenses are reimbursed?
• How much less am I reimbursed if I use doctors outside the insurance company’s network?

2. Does the insurance plan cover the services I am likely to use?

• Are my current medical care providers in the insurance company’s network?
• Am I able to use a doctor outside the network?
• Can I change primary-care physicians if I want to, and how difficult might that be?
• Do I need a primary care physician referral see a specialist?
• What about emergency care and/or reimbursement for at home or out of town situations?
• Are preexisting medical conditions covered?
• I have a chronic condition... asthma, cancer, AIDS or alcoholism... how will the plan treat it?
• Are the prescription medicines that I use covered by the plan?
• Are alternative medical therapies such as acupuncture or chiropractic treatment reimbursable?
• Does the plan cover the costs of delivering a baby?

3. What is the quality of the insurance plan?

• How have independent government and non-government organizations rated the plan? For example, the National Committee for Quality Assurance (http://www.ncqa.org ) issues a Consumer Assessment of Health Plans (CAHPS) report for every medical plan and facility.
• What kind of accreditation has the plan received from groups such as NCQA or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) ( http://www.jcaho.org )?
• How many patient complaints were filed against the plan last year and how many were upheld by state regulatory agencies like the state insurance commission or the state medical licensing board?
• How many members drop out of the plan each year? State insurance departments keep track of “disenrollment rates.”
• Do the doctors, pharmacies and other services in the plans offer convenient times and locations?
• Does the plan pay for preventive health care such as diet and exercise advice, immunizations and health screenings?
• What do my friends and colleagues say about their experiences with the plan?
• What does my doctor say about his or her experience with the plan?