How to Talk to your Employer about Health Care Options

Whether you just started a new job or are anticipating the next open enrollment period at work, you’re likely going to want to take a good look at the health care options your employer offers. But once you start looking, you might get confused by the choices. How do you know which one is right for you? The best thing to do is talk to someone in your human resources or benefits department. To understand your choices here are some of the main questions you should ask:

  1. What are the types of plans available? Many employers offer at least two options: an HMO and PPO. HMOs often cost less but require you to select a primary care physician and receive services only from HMO health care providers. And to see anyone besides your primary care physician, you need a referral. PPOs typically cost more than an HMO but give you the flexibility to see who you want and when. Blue Cross Blue Shield of Michigan does have a new, third option—Blue Cross® Personal Choice PPO. This plan gives you the flexibility of a typical PPO while saving you money. You can receive lower costs by using Organized Systems of Care, communities of doctors and hospitals, to coordinate your care.
  2. What are the costs of the plan? Don’t just look at premiums (the amount usually taken automatically out of each paycheck by your employer). You’ll also want to know the cost of seeing a doctor (known as a copay), how much you have to pay before the insurance kicks in (deductible), what percentage of services you’re responsible for after your deductible (coinsurance) and what prescription coverage is included
  3. Is dental and vision included or is that extra? Other than what is required for health care reform, dental and vision are usually additions to your medical plan if offered by your employer.
  4. How many doctors are in this plan? Some lower-cost plans offer local networks or limit the doctors and hospitals you can use. Know what access to doctors and hospitals you have before choosing a plan.
  5. Can you set up a HSA or FSA? Some employers allow you to set up a flexible spending account (FSA) to help pay for medical expenses with pre-tax money. Another option is to see if one of the health plans is approved for using a health savings account (HSA), which is similar to an FSA. A plan typically needs to have a high deductible to be HSA-compatible.

Choosing a health plan can be confusing; learn more about the Personal Choice PPO. For more on employer-sponsored health plans, check out these other posts:

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