Healthcare Plan HMO PPO Traditional Indemnity
What is the plan year (effective dates)?
Is your plan an HMO, PPO, traditional indemnity or other type of plan? How do you know this; where did you find this information?
Where does a co-pay apply within your coverage? How does co-pay impact your decision to access healthcare?
What is a deductible, in your policy what is your deductible?
Where does co-insurance apply within your coverage? How is co-insurance different from co-pay?
Are you required to identify a PCP when you enroll (a “gatekeeper” model)?
Where does pre-certification or pre-authorization apply within your coverage? How does this requirement impact your decision to access healthcare?
Describe the use of a formulary when a policy has pharmacy benefits, does your coverage provide this service?
What (if any) wellness benefits are covered in your plan?
What is meant when a policy has “out of network” stipulations, does this impact your decision to access healthcare?