Finding A Health Plan That Is Right For You

Choosing the right health plan is important. It can also be challenging. Today there are more choices and more kinds of health plans than ever before.

What Should I Know Before Choosing A Health Plan?

Coverage:

What services does the plan cover? What are the deductibles? Does it cover home care, chiropractic services, mental health services, or anything else that is particularly important to you?

Choice:

Is there a certain doctor you’d like to choose, either for routine care or specialty care? Do you have to choose a physician from among those specified? Do you have a primary care hospital? If you have different rules for “emergency care” and “urgent care” how do you define the difference between the two?

Convenience:

Does your plan cover physicians who are located near your home or office? What is the procedure if you choose a physician and then find that you do not like him/her?

Cost:

You will pay all or part of the premium directly or through payroll deduction, plus a visit fee, or co-payment, whenever you get care. If your coverage is through your employer, your benefits manager can tell you what your portion of the premium will be. If you are in a Medicare managed care plan, there may be no premium.

Other:

• Are the deductibles one time only, or yearly?  
• Is the insurance provider financially stable?  
• Is the plan accredited by the National Committee for Quality Assurance (NCQA)? The NCQA is a non-profit watchdog organization created to assess, measure, and report on care provided by the nation’s managed care groups. Since 1991, NCQA accreditation surveyors--mainly doctors--have evaluated a health plan’s organization, structure, and quality improvement processes to see whether the plan was capable of delivering high quality care and continually improving the care it provided.  
• How long has the company been in business?  
• What is the average turn-around time on claims?

Put It All Together:

Is the combination of cost, quality, coverage, and access to your preferred physicians or specialists, acceptable?

Questions? Please call the Lourdes Physician Referral Number at 1-877-9LOURDES.