Your Medical Insurance Checklist

Your  medical insurance checklist should be reviewed as your new coverage becomes effective January 1.  Here are some items to consider:

1. Current Medical Insurance Card

Carry this in your wallet. Take a picture and keep it on your phone. If you and your significant other have different insurance coverage, you might want to each carry a copy of the other’s insurance information; just in case.

2. Know which Type of POlicy You have

Will you be covered by an HMO; requiring a primary physician to make any referrals for treatment?  Do you have a PPO? This allows for more flexibility in your treatment options, though the plans continue to become more limited each year. Do you have an EPO? This covers only providers designated as part of the network and having you obligated for all payments outside of this designated network.

3. Create an Online Account with Your Medical Insurance Provider

This one is critical.  If you don’t have an insurance card, you can print one.  Your benefits of coverage can be found. Your claim history, including payments and pending statements, are available.  And, your deductible and out of pocket obligations will be listed.

4. understand your medical insurance benefit coverage

You should have received a Statement of Benefits following the open enrollment period.  This Statement outlines your benefit coverage in detail. It can also be found online from your insurance provider.  Or, ask your Plan Administrator for a copy. This should be kept on file as a reference for you during the year.

Before you have to use your medical insurance, know what your co-pay responsibility is for any doctor, therapy, or related health visits you have. If you require physical therapy: do you know the number of visits you are allowed in a plan year?

Become familiar with your pharmacy co-pay obligations.  Pharmacy charges will usually not be included in reaching your out of pocket expenses.

If you have multiple policies; such as Medicare and supplemental insurance, become familiar with who provides primary coverage for your care and when the secondary policy will begin to pay.

5. Understand your in network and out of network medical insurance coverage

If you haven’t already checked, now is the time to make sure that the health care providers whom you use most often are covered by your medical insurance policy.  If not, you will be paying at out of network rates.

6. understand your medical insurance financial obligations

Become familiar with your monthly premiums and how you will pay them.  If you have lower monthly premiums, most likely you will be paying higher co-pays and deductibles.  If you are not anticipating any major need for care during the year, the lower premium plans are a definite consideration.

7. Become familiar with your Medical Insurance resources

If you are obtaining insurance through your employer, there should be a plan administrator available to assist with any questions or problems you might experience with your policy.  You can contact your insurance provider directly, by phone or through chat lines on their website, to verify coverage and answer your questions.  Or, you can contact a healthcare advocacy consultant for assistance in understanding your policy, assisting with any questions regarding billing issues, and helping direct you to the best source for assistance in resolving medical insurance matters.

I recommend that you review the medical insurance checklist at least every six months, if not quarterly.  If you are utilizing your medical insurance with some frequency, you should routinely review your insurance payment information online. You are responsible for understanding your medical insurance coverage and financial obligations associated with the policy.  Know what coverage you have before you need to utilize it.


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