Plan selection mistakes

Common Health Plan Selection Mistakes

For many, open enrollment is right around the corner. Selecting an appropriate health plan can be difficult.  While there are many helpful resources that offer instructions on how to weigh plan options, for some, it is more beneficial to know common pitfalls and mistakes to avoid.

Some common missteps include:

Not thoroughly reviewing all enrollment options. Comparing different plan options can be stressful, and an employee may be tempted to solely rely on recommendations from others. Unfortunately, friends, family, and coworkers may not know all of the employee’s medical and financial information to offer reliable guidance. Employees should understand how policies, coverages, networks, and costs measure up against their needs in order to make an informed decision.

Skimming important policy documents. When an individual skims a policy’s terms and conditions, its inclusions and exclusions, surprise bills may appear in the future. Knowing a plan’s expectations is vital.

Misinterpreting costs. It is incredibly easy for an employee to choose a plan misaligned with their needs because they did not understand the insurance terms. When a plan mentions a cost-sharing charge, it’s the amount the employee must pay for a service or medical item covered by the health plan. Most plans have:

  • A deductible—the amount the employee pays out of pocket before the health plan begins to cover costs.
  • Coinsurance—the percentage the employee pays after meeting the deductible for covered health services.
  • A copay—the fee the employee pays upfront. This can include doctor visits, prescriptions, and more.

Not confirming in-network coverage. An employee must make sure their physician and pharmacy are connected to their desired plan. Choosing a plan that considers the employee’s preferred physician and pharmacy to be out-of-network can quickly become expensive. Additionally, it is important to determine in advance whether the desired plan covers brand-name and generic versions of the employee’s regular prescriptions or specialty medications.

Dismissing add-ons as viable choices. Once employees realize that health insurance add-ons are offered separately and with an additional premium, they are quickly overlooked. However, add-ons can bridge significant coverage gaps left by the standard health plan. If an employee has specific health needs that require bolstered protection, an add-on might be a smart decision. Critical illness insurance and maternity and newborn insurance are examples of common add-ons.

Sharing inaccurate medical history. Revealing certain health conditions may indeed result in higher premiums or an overall rejection; however, concealing them could lead to claims being denied. In the long term, it may result in costly bills.

 

Health plans can typically only be elected or changed once a year, during open enrollment, so selecting the most suitable plan is imperative. If you have any questions about open enrollment, please contact your dedicated Creative Benefits, Inc. team member.