HEALTH INSURANCE Shopping Tool

HEALTH INSURANCEShopping Tool

Prepared by the National Association ofInsurance CommissionersAs part of our state-based system of insurance regulation in the United States,the National Association of Insurance Commissioners (NAIC) provides expertise,data, and analysis for insurance commissioners to effectively regulate the industryand protect consumers. The U.S. standard-setting organization is governed by thechief insurance regulators from the 50 states, the District of Columbia and five U.S.territories. Through the NAIC, state insurance regulators establish standards andbest practices, conduct peer reviews, and coordinate regulatory oversight. NAICstaff supports these efforts and represents the collective views of state regulatorsdomestically and internationally. For more information, visit www.naic.org.National Association of Insurance Commissioners1100 Walnut Street, Suite 1500Kansas City, MO 64106-2197(816) 842-3600 2018 NATIONAL ASSOCIATION OF INSURANCE CO MM I S S I O N ERS

There is more to shopping than just finding the lowest premium. What you pay each month for health insurance (the premium)is important, but you also need to understand what the policy covers. A policy with a lower premium seems like a better deal.But, a lower premium could mean less coverage—or that you will pay more out-of-pocket for your health care.This three-part tool will help you compare health insurance policies and find the policy thatbest meets your needs.STEP 1Identify your current health care needs—doctors, services, and prescription drugs. Keep these in mind as you compare policies.STEP 2Compare health insurance policies. See how they measure up against your current policy.STEP 3Compare costs. Think about the out-of-pocket costs you may have to pay as well as the monthly premium.HEALTH INSURANCE SHOPPING TOOL3

STEP 1: IDENTIFY YOUR CURRENT NEEDSWho will this healthinsurance cover? (Circle one.)Just meMe and my spouse/partnerMe and my family(incld. dependent children)List my health conditions andthose of my family membersthe policy will cover. Theseare considered pre-exisitingconditions.List the health care servicesor prescription drugsregularly used if needed.Do I or family membershave doctor(s) that I or theyregularly see? Do I have ahospital I prefer to use?Doctors (primary care, specialist, etc.):Facilities (hospitals clinics, etc.):HEALTH INSURANCE SHOPPING TOOL4

STEP 2: COMPARE HEALTH INSURANCE POLICIESAsk these questions when you're talking to an insurance company, agent, or navigator. You can jot down this information as youare reviewing policy information, like Summary of Benefits and Coverage (SBC) document.POL I CY 1P OL I C Y 2P OL I C Y 3YES or NOYES or NOYES or NOYES or NOYES or NOYES or NOName of Plan:Name of Insurance Company:Does the policy require that I use a specificnetwork of doctors and hospitals?If so, are my doctors and hospital in the network?How long does coverage under this policy last?Will my doctor or hospital directly bill theinsurance company? Or do I have to payupfront and get reimbursed?Is there a point where I no longer have to payanything out-of-pocket for health care (anannual maximum out-of-pocket)?Does this policy cover pre-existing conditions?(See your list.)M A X IM U M :M A X IM U M :M A XIM UM :YES or NOYES or NOYES or NOYES or NOYES or NOYES or NOHow long before coverage starts? Is there awaiting period for any health conditions?In the event I develop a health condition, canthis policy be cancelled or not renewed, evenif I paid my premiums?HEALTH INSURANCE SHOPPING TOOL5

WHAT DOES THIS POLICY COVER: Ask which services are covered and what you'll pay out-of-pocket. The out-of-pocketamounts you'll pay will be either co-pays (a dollar amount) or a coinsurance amount (a percentage of the cost, after thedeductible is met). Some policies may limit the number of covered visits or limit how much will be paid for each type of visit.Make sure you also ask about any limits.POL I CY 1COVERED?P OL I C Y 2OUT-OF-POCKETOUT-OF-POCKETCOST/LIMITS ONCOST/LIMITS ONSERVICESCOVERED?SERVICESP OL I C Y 3OUT-OF-POCKETCOVERED?Physician/Primary Care Office VisitYES or NOYES or NOYES or NOSpecialist Office VisitYES or NOYES or NOYES or NOPreventative Care (Physicals, Wellness Visits,Immunizations)YES or NOYES or NOYES or NOUrgent CareYES or NOYES or NOYES or NOHospital Emergency Room CareYES or NOYES or NOYES or NOHospital Inpatient CareYES or NOYES or NOYES or NOOutpatient ServicesYES or NOYES or NOYES or NOLabaratory ServicesYES or NOYES or NOYES or NOMaternity CareYES or NOYES or NOYES or NOMental Health and Substance Abuse - InpatientYES or NOYES or NOYES or NOMental Health and Substance Abuse - OutpatientYES or NOYES or NOYES or NOChiropractic, Physical, Occupational or SpeechTherapyYES or NOYES or NOYES or NOHEALTH INSURANCE SHOPPING TOOLCOST/LIMITS ONSERVICES6

PRESCRIPTION DRUGSPOL I CY 1P OL I C Y 2P OL I C Y 3Does this plan cover prescription drugs?YES or NOYES or NOYES or NODoes this policy cover the drugs I use? Are thereany limits or requirements for approval before Ifill a prescription?YES or NOYES or NOYES or NOWill I have to pay out-of-pocket for prescriptiondrugs? You may have to pay different amounts (i.e.co-pay) for different types of drugs.YES or NOYES or NOYES or NOList out your prescription drugs, includinggeneric, brand name, mail order, and specialtydrugs, and the associated costs: HEALTH INSURANCE SHOPPING TOOL7

STEP 3: COMPARING THE COSTSWhat will I have to pay out-of-pocket, in addition to premiums?POL I CY 1P OL I C Y 2P OL I C Y 3DeductibleIn-Network: Out-of-Network: Separate deductible for certain services (forexample, drugs).Services this applies to: Does this policy have any limits on the coverage?POL I CY 1P OL I C Y 2P OL I C Y 3Annual limit on coverage.I pay all costs after this amount each year. Lifetime limit on coverage.I pay all costs after this amount. Premium InformationPOL I CY 1P OL I C Y 2P OL I C Y 3How much will I pay for coverage each month? Are there any other fees like application ormembership fees? Will I pay more because I have pre-existingconditions?YES or NOYES or NOYES or NOWill I receive financial help with the out-of-pocketcosts?YES or NOYES or NOYES or NOAm I eligible for any premium subsidies with thispolicy?YES or NOYES or NOYES or NOHEALTH INSURANCE SHOPPING TOOL8

This three-part tool will help you compare health insurance policies and find the policy that best meets your needs. STEP 1 Identify your current health care needs—doctors, services, and prescription drugs. Keep these in mind as you compare policies. STEP 2 Compare health insurance policies. See how they measure up against your current policy .