Shopping for health insurance

This section provides information about how to get the most out of your health insurance coverage. It can also help you decide if the coverage you have is right for you.

Tips: checking out a plan
Make sure the coverage you buy fits your needs, and that you receive the best price for the coverage. You should compare benefits and rates. Look at two or three different plans to compare them against your needs as well as to one another.

• Benefits: Make sure you understand the plan’s benefits. Look at what the contract will not cover, not just what it will cover.
• Limitations and exclusions: Find out if there are special requirements to obtain benefits. For example: Do you need prior authorization for some services? How do you obtain that authorization? Are there waiting periods before coverage goes into effect?
• Claims: Before you buy, make sure you understand how to file a claim, where to send it, and how you will receive payment.
• Costs: Premiums for health insurance vary. When reviewing several companies, look carefully at the benefits they offer.

Tips: checking out an agent
Many people buy health insurance from agents or companies. Agents may represent only one or a number of companies. Companies can sell their policies by mail, the Internet or over the phone.

Agents earn a commission on your business and should do more than just sell you a policy. They should also answer your questions.
If you need additional information, contact your agent or the company. You are the customer, and they should respond to you.
Never deal with an unlicensed agent. Ask to see his or her license. You can check on an agent’s.
Never buy an insurance policy you do not understand. Ask to see the benefits explained in writing in simple terms. Keep that piece of paper with the policy after you buy it.
If you need a translator to talk to your agent or company, arrange for an adult translator to accompany you.
Never give any insurance representative money or a check without getting a receipt.
Never give out your bank account or Social Security information over the phone.

Tips: checking out an insurance company
Before you buy health coverage, find out about the company selling the plan. Here are key factors to consider:

Customer service. Find out how the company services its members. Does the company have a toll-free customer service number? Do they answer it without a long wait?

Financial stability. Financial stability helps ensure that a company can pay its claims. In addition, Washington state law establishes requirements that each company must follow. The Office of the Insurance Commissioner (OIC) continually monitors insurers to make sure they are financially stable. Independent organizations also rate the financial stability of insurance companies. Check your public library’s reference desk for published ratings.

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