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  Finding a Health Plan That's Right for You  
 
Know What You Need

Make a list of the health issues that are most important to you and your family.

For example: Planning a family? You may want to research the types of family care benefits within a specific health plan. Have you been diagnosed with diabetes or high blood pressure? Has anyone in your family suffered a catastrophic illness?

You may also want to research whether the plan offers a drug prescription program, alternative medicine, coverage for eyeglasses, and other such options.

Do you want to continue to see your current doctor? Make sure that doctor participates in the health plan. If the doctor does not, look ingot what your financial responsibility would be if you used an out-of-network doctor. To find this out, you can call the plan's member services department or call the provider directly. Refer to the "Choosing a Physician" sidebar on this page for more information.

You've heard the saying, an ounce of prevention is worth a pound of cure. Check to see what kind of preventative medicine and screenings the plan you choose offers.

Know how much you can afford. Out-of-pocket expenses include more than the monthly premiums. Refer to the "Cost" sidebar on this page for more information.

Make sure the plan includes the types of doctors and services you need and that are conveniently located near you and your family.

Know What You Want

Now that you know what you need, it's time to determine what you want. The first step is to find out what benefits and services each plan offers.

If you are choosing a health plan through your employer, your human resources department should be able to provide you with a handbook for each of the plans they are offering.

If you are a small business employer or if you are an individual looking for health insurance you have several options.

You may be eligible for the INdividual Health Insurance program if your employer does not offer health insurance, if you are not employed, or if you are not eligible for Medicare. To find out more about your options, contact the New Jersey Department of Banking and Insurance at (800) 838-0935.

If you are a small business owner, you can find out more about what options are available to you by contacting the New Jersey Department of Banking and Insurance and asking about the Small Employee Health Benefits Program at (800) 263-5912.

Once you determine your needs, focus on the major differences in each plan to make an informed decision about your health care.

Compare your list against the benefits package to make sure that what you need is included in the benefits package you are considering.

Most importantly, find out what types of care the plan does NOT offer.

Choosing a Physician

If you are in search of a new physician, consider the following:

You have a right to know. Ask questions. What's their background? Where did they get their training? How long have they been in the plan? Is the doctor board certified in their specific area of expertise?
Get recommendations. Ask family, friends, other health care providers, hospitals.
Make sure their office hours and locations are convenient to you and your family.
For more information on New Jersey physicians, including disciplinary actions, call the New Jersey State Board of Medical Examiners at: (609) 826-7100 or visit their website and click on "Online Licensee Directories."
Cost: Know How Much
You Want to Spend

To many, cost is a major consideration when choosing a health plan. But depending on the types of care or benefits one plan may offer versus another, you may find yourself paying more out-of-pocket expenses than you expected. Depending on your individual needs, a plan with a higher premium doesn't necessarily mean that you're spending more on your health care.

Consider what you'll be paying for when choosing a health plan:

Premiums: The cost for the health plan.

Co-Payments: The fixed fee for utilizing network services such as doctor or emergency room visits and filing a prescription.

Co-Insurance: The part of the cost of health care services that the patient must pay. This is generally identified as the percentage of the cost shared with the insurer (such as 20% paid by the patient and 80% paid by the insured).

Deductibles: The amount that you must pay out-of-pocket before your insurance is activated to pay for your health care.

Out-of-Pocket Maximum: Some plans put a limit on how much you are responsible to pay.

Annual or Lifetime Maximum: Some plans limit the amount that the insurer is responsible to pay.

 
   
New Jersey Association of Health Plans · 50 West State Street, Suite 1012 · Trenton, NJ 08608 · Phone: (609) 581-8237 · Fax: (609) 278-4496