Health Insurance Benefits
[Of all health insurance benefits, maternity coverage is the one most often not included in individual coverage (if not mandated by state law), because it may be a planned claim, not an unexpected catastrophic expense. Preventive care is also one of the health insurance benefits that is more likely to be skimpy or non-existent in an individual plan because if it is a benefit, the premiums must be raised to pay the cost anyhow. So except for HMO's, why include it as one of the health insurance benefits when the insureds could pay a lower monthly premium and pay their own preventive expenses themselves? - ed.]
3. What Plan Benefits Are Offered?
Most plans provide basic medical coverage, but the details are what counts. The best plan for someone else may not be the best plan for you. For each plan you are considering, find out how it handles:
- Physical exams and health screenings.
- Care by specialists.
- Hospitalization and emergency care.
- Prescription drugs.
- Vision care.
- Dental services.
Also ask about:
- Care and counseling for mental health.
- Services for drug and alcohol abuse.
- Obstetrical-gynecological care and family planning services.
- Ongoing care for chronic (long-term) diseases, conditions, or disabilities.
- Physical therapy and other rehabilitative care.
- Home health, nursing home, and hospice care.
- Chiropractic or alternative health care, such as acupuncture.
- Experimental treatments.
Some plans offer members health education and preventive care, but services differ. Ask questions such as:
- What preventive care is offered, such as shots for children?
- What health screenings are given, such as breast exams and Pap smears for women?
- Does the plan help people who want to quit smoking?
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[Health insurance benefits in an employer plan are an employee benefit that an employer may want to provide as an enhancement to the benefits package. Health insurance benefits in an individual/family plan are strictly a consumer decision. When buying as an individual, you have to decide what health insurance benefits are worth paying for. Compare carefully, because there can be surprising differences in health insurance benefits.]