When shopping for a health insurance policy, many people only look at three items:

• Price
• Deductible
• Co-payments

The problem with doing this is that these people are only looking at a small part of the picture. Most of these people who wind up using their insurance will discover that they didn’t get the coverage that they had envisioned when they purchased it.

Price, deductible, and co-payments are important considerations when deciding on insurance plans, but there are some others that you should also consider, such as:

• Your plan’s out-of-pocket requirements. Deductibles and co-payments are only a part of your plan’s overall out-of-pocket requirements. In fact, an insurance policy’s deductible is normally less than half of what you may have to pay out of your pocket when receiving medical care. Be sure you understand the maximum out-of-pocket you may have to pay in the event that significant medical is needed.


• Your plan’s limitations and exclusions of coverage. Some plans may limit expenses for a doctor visit to only $50, only $600 for a hospital stay. Also, coverage for items such as rehabilitation, allergies, diabetic treatment, and others have been known to be excluded or severely limited by health insurance plans. Make sure your plan description or brochure explains these and that you can live with any limitations.


• What medical providers will participate on your insurance plan? After you make sure your family doctor and children’s pediatrician are covered under your plan, make sure it also offers a strong selection of specialists. Otherwise, you may have to travel to another city to receive the specialized care you need. Also, make sure that major institutes and hospitals are also readily accessible should you need care from these facilities. Having the right specialist and hospital could make a big difference in your recovery.


• How good has the health plan’s claims service been? Ask your agent (and others who have coverage under this plan) how well the insurance company pays its claims. Don’t put too much stock in a friend’s recommendation if your friend has never used his or her plan for more than an occasional doctor visit or prescription refill. Find out if the company pays its claims on a timely basis. Also, see if they make a lot of mistakes or require a lot of follow-up on your part to get the medical bills paid.

Your doctor’s office may also have some insight. When you call, be sure to ask for the person who actually works with the insurance payments. The clerk at the desk may have very little understanding of insurance, and you could get information from someone who knows less about insurance than you do.

Will my health plan likely have larger than average rate increases? If an insurance plan can’t deliver on the previous six issues, it is not a good program at any price. Instead of just the monthly premium, you really should consider the total cost of the health insurance plan. In all likelihood, the monthly premium is what you’ll be paying for the next 12 months. If in that time you develop a medical condition, you might not qualify for insurance with another company – or, the coverage offered to you may be under very poor terms. If you cannot change insurance companies, hopefully you selected a plan that is expected to fare better than average in the rate increase department. Find out what the health insurance plan’s rate increases have been in the last four quarters and few years. This will give you some insight into future increases for next year and the years to come. In today’s environment, because of rapid medical inflation, it is not a question of whether you will get a rate increase – but how much of a rate increase you’ll get. There are wide rate increase differences between insurers – but in some cases, people have seen their premiums double in less than three years.