Whether you end up choosing a fee-for-service plan or a form of managed care, you must examine a benefits summary or an outline of coverage – the description of policy benefits, exclusions, and provisions that makes it easier to understand a particular policy and compare it with others.

Look at this information closely. Think about your personal situation. After all, you may not mind that pregnancy is not covered, but you may want coverage for psychological counseling. Do you want coverage for your whole family or just yourself? Are you concerned with preventive care and checkups? Or would you be comfortable in a managed care setting that might restrict your choice somewhat but give you broad coverage and convenience? These are questions that only you can answer.

Here are some of the things to look at when choosing and comparing health insurance plans.

Health Insurance Checklist

Covered medical services

  • Inpatient hospital services
  • Outpatient surgery
  • Physician visits (in the hospital)
  • Office visits
  • Skilled nursing care
  • Medical tests and X-rays
  • Prescription drugs
  • Mental health care
  • Drug and alcohol abuse treatment
  • Home health care visits
  • Rehabilitation facility care
  • Physical therapy
  • Speech therapy
  • Hospice care
  • Maternity care
  • Chiropractic treatment
  • Preventive care and checkups
  • Well-baby care
  • Dental care
  • Other covered services

Are there any medical service limits, exclusions, or preexisting conditions that will affect you or your family?

What types of utilization review, pre authorization, or certification procedures are included?

Costs

How much is the premium?

  • $_____________________________________________

Are there any discounts available for good health or healthy behaviors (e.g., non-smoker)?

  • __________________________________________________________________

How much is the annual deductible?

  • $_________________________________ per person
  • $_________________________________ per family

What coinsurance or co-payments apply?

  • _________________________________% after I meet my deductible
  • $_________________________________copay or % coinsurance per office visit
  • $_________________________________copay or % coinsurance for “wellness” care (includes well-baby care, annual eye exam, physical, etc.)
  • $_________________________% copay or coinsurance for inpatient hospital care