A brief interview with a reputable broker that asks the right questions and listens to your needs should result in choosing the company and level of service that will best fit your needs.

Dr. Copay. You do not have to meet your deductible to take advantage of your doctor copay. Doctor copays go into effect on the date your policy is issued. Some companies allow you to purchase their plans without a doctor copay option. If you historically see your doctor 1 or 2 times a year, you may want to save money and choose a plan without the doctor copay option. If you do not purchase the copay option, you still take advantage of any PPO discounts and your doctor visits go toward meeting your deductible.

Deductible: The amount you must pay (excluding doctor co-pay and prescriptions) before your plan starts paying for any services. The higher your deductible, the lower your premium. You need to decide what deductible you are comfortable paying.

Co-insurance: Your share of the bills after you meet your deductible. Most health plans today are 80/20, some 70/30 and some 50/50.

Coinsurance limit 20% 0f $5000= $1000 maximum exposure plus your deductible. 20% of $10,000= $2000 plus your deductible. Some companies list coinsurance to the maximum you pay. 50% with out of pocket of $1250 or $2500: 10% to $3500 or 20% to $4000. Some higher deductible plans pay 100% after you meet your deductible. It is important to know your coinsurance plan limit. (Stay away from any plan with an unlimited coinsurance)

Maximum Out of Pocket (MOOP) (In my opinion this is more important than your annual deductible) Maximum Out of pocket is your Annual Deductible plus your Co-insurance limit. What are the plan coinsurance limits? Your deductible plus $2000 or higher. Family Maximum out of pocket: Most plans limit the family Maximum out of pocket to 2 family members. Some plans are an aggregate of 3 family members and there are companies that require each family member to meet the deductible and coinsurance limits. Find out what your individual and family maximum out of pocket exposure is before your purchase any plan.

Prescription Card: Every company treats prescriptions differently. Your prescription copay card is a separate issue from your plan deductible and Maximum out of pocket. Prescription costs are increasing each year and are a driving force in rate increases. A lot of prescription cards now have a separate annual deductible. If you do not purchase a prescription card, do your prescriptions go toward your deductible? If you meet your MOOP are prescriptions covered at 100%? Find out how each company handles prescriptions.

Pre Existing Conditions: How does the plan handle pre existing conditions? A pre existing condition can be rated up,

ridered out (not covered at all) or it can result in your application being denied. Will the company place an exclusion rider on your pre existing condition? Is this important to you? If you are replacing coverage, will your new plan place a waiting period on pre existing conditions? These are questions you must ask your broker or agent before you enroll for coverage.

Lifetime maximum coverage: Choose a plan with at least $2,000,000 lifetime maximum coverage. Do not choose any plan that has an Annual Limit on total benefits paid.

Broker or Agent: You want A Broker or Agent that is licensed with multiple companies and can shop the market to find you a plan that meets your needs. Any agent that can only show you one company works for the insurance company, not you. Your monthly premium is the same if you go direct with the company or through an independent broker or agent. Some companies allow you to purchase their plans directly from them. If you go direct and need service after you purchase your plan, you will eventually be disappointed. By Law, there is no additional charge to you if you purchase your health insurance through a broker or agent.

You are spending your money on an important and expensive service. If you are pressured to make a decision to enroll in a certain plan and do not purchase any plan you do not understand. Don’t be rushed to make a decision.

Be comfortable with your agent and with your policy before you purchase any health plan.