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Question and Answer Column from
Georgia Insurance Commissioner John Oxendine


 

Q: I’m in the process of choosing among health insurance options offered at my place of employment.  What advice do you have for someone making that decision?
A: Many companies across the country hold open enrollment periods for their group health insurance plans.  Open enrollment refers to the period of time during which all members of your group health insurance plan have the opportunity to enroll in certain benefit programs. During an open enrollment period, insurance carriers are required to accept all applicants of the group without underwriting or evidence of insurability.  Open enrollment is generally only held once a year.  If you miss your company’s annual open enrollment, you likely will not be able to enroll in your employer-sponsored health insurance program until next year.  Certain exceptions apply for new employees or employees with life-changing events.
There are many different types of major medical plans typically offered by employers.  For help understanding the fundamental differences between preferred provider organizations (PPO), health maintenance organizations (HMO), point of service plans (POS) or indemnity plans, you can go to www.InsureUonline.org and click on the life situation that most closely matches your own.  The health section includes basic information, provided by the National Association of Insurance Commissioners (NAIC), about each type of program.
Plan materials provided by your employer will detail which medical providers (physicians, hospitals, labs, pharmacies, etc.) are considered in-network and out-of-network.  They will also detail how much the insurance carrier will pay under each type of plan.
Check to see if your current physicians and area hospitals are in the plan’s network.  Using network providers generally will save money on your health care.
Are spouses or dependents covered?  Some plans will cover spouses and other dependents, while others will not.  
Read all of the plan materials thoroughly.  Doing so will tell you what your rights and responsibilities are under each plan.
Review any pre-existing condition exclusions and prior authorization requirements.  If you take prescription medications, check them against the list of approved drugs in each plan booklet.
If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.
If you are not satisfied with the answers to your questions, you can contact our Consumer Services Division at 1-800-656-2298 for assistance.   
In this uncertain market, it’s important to carefully evaluate your healthcare costs when making your annual enrollment decisions.
Please send your insurance questions to:
Insurance Commissioner John Oxendine
716 West Tower
2 Martin Luther King Jr. Drive
Atlanta, Georgia  30334
Or call 404-656-2070 (toll free at 1-800-656-2298), from 8 a.m. to 7 p.m. weekdays, for assistance with an insurance question.  
Website www.gainsurance.org



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