Health insurance, we all need it, it gets more expensive every year, and instead of becoming easier to understand it only gets harder…deductible, deductible credit, copay, coinsurance, preventive care, tiered RX programs, maximum out of pocket. The list goes on and on…

Here are 5 Key things you need to know in case you have a major medical claim on your policy. Not knowing these can cost your THOUSANDS of dollars and untold headaches. Here they are:

1. Is you deductible a family deductible, individual with maximum, per person, or per incident? This can make a huge difference if you have a major claim and you expect to pay one $5,000 family deductible and then find out it’s really a per person, worse still a per incident. This could triple or more the amount you have to pay to meet that deductible – be sure!

2. Do you have in-network coverage for emergency services? Some health insurance plans always cover emergencies, no matter where they happen and are treated as in network and as such you pay a A LOT LESS MONEY. Some plans do not…

3. Is wellness covered according to the new Healthcare Reform law? If it’s real major medical insurance all of your wellness, subject to government guidelines, will be covered at 100% with no deductible, no coinsurance, and no deductible. Free preventive care for all right? Wrong, if y ou have a short term plan, a limited benefit plan, or a discount plan you won’t be able to take advantage of this benefit. Again, look at your policy and see what it says.

4. What is your coinsurance rate and your TRUE maximum out of pocket? This differs from plan to plan and carrier to carrier. Typically your maximum out of pocket will be your deductible, any applicable coinsurance maximums, and any copays plus the premium you spend for the year. Seems like pretty easy math right? It’s usually not so cut and dry. Each health insurance plan calculates maximum out of pocket differently. Some have 0% so once you meet your deductible the insurance pays the rest. Some have 50/50, 70/30, 80/20 or even 90/10. Where you have to understand is how the calculate coinsurance maximums. Some are simple like 0%. Some are more complicated. 30% coinsurance to a maximum of $3,500….per insured on the policy! What if you have 5 kids and get into a car accident? What then?

5. How are claims handled? How long does it take? Will you talk to a live human being or a robot attendant, “push one for claims”, “I didn’t get that”. How frustrating is that. Does your insurance company offer you dedicated assistance and resources to help you put the pieces back together so you can focus on getting well.

As you can see health insurance has a lot of moving pieces, is more difficult to understand then ever and is becoming more and more expensive. Don’t leave it to chance or an online wizard. Talk to a professional, a live, licensed agent. There’s no coast or obligation and you will get personalized service and solutions that make sense for your situation not some cookie cutter deal.

We hope this information helps to open your eyes. Feel free to visit us online or call us direct should you have questions, need coverage, or would like a policy review to see if your in the best plan.