Colleen M. Murphy
Over the past few weeks, PlanSmartChoice has participated in almost 100 health fairs in Washington, D.C. and around the country. We have talked to literally thousands of federal employees about their health insurance needs—medical, dental, and vision—and thought we would share some of this year’s most popular questions with you.
I want to add my 25-year old child to my medical coverage, but he/she lives in another state. What do I do?
As of January 1, health reform makes it possible for employees to add children up to the age of 26 to their medical coverage. OPM created a “FastFacts” of eligibility rules and required forms at www.opm.gov/insure/fastfacts to help you. If the child doesn’t live with you, make sure to enroll in a national plan or a regional plan that covers both residences.
How do I choose a plan if I have a limited monthly budget?
Many of us can only afford to spend a certain amount every month on our health care, so it’s important to consider both our monthly premiums and out-of-pocket expenses. “Budget mindful” employees can use the Medical Cost Calculator to estimate their total costs under different circumstances for each medical plan option. Then, simply choose the plan that works best for your budget.
What if I am worried about my family’s financial security?
These “security conscious” employees are worried about the effect of a catastrophic event on their family’s finances. They will want to use the Preference Module to trade off between annual out-of-pocket maximum and other plan features, such as monthly premium, to be sure that their family is protected. And, as of January 1, health reform requires all medical plans to have unlimited lifetime maximums.
How do I find out about coverage for a specific medical concern?
If you have a child with asthma or a drug problem, an infertile or pregnant spouse or partner, or your own bad back, this condition will drive the selection of your health plan. “Medically needy” employees can use the Comparison Module to compare benefit coverage for specific services and obtain additional details from the medical plans’ Plan Brochure (i.e., Summary Plan Description).
What if I have had services issues with my health plan?
If you’ve had a bad experience with your health plan, you’ll want to compare satisfaction scores across medical plans. “Satisfaction savvy” employees can use the Comparison Module, which contains survey results (obtained from the Office of Personnel Management for federal employees) for claims processing, getting care quickly, getting needed care, doctor communications, and medical plan cost data.
How can I be sure that my doctor is in the network?
If your relationship with your doctor is important to you, “provider picky” employees should do three things to be sure that he or she is in a medical plan’s network:
- Link to a health plan’s web site from any of the PlanSmartChoice results pages and go to the provider directory.
- Call your doctor’s office and ask the office administrator (not your doctor) if your doctor and his/her office is part of the plan.
- Realize that provider networks often change. Be sure that the plan has out-of-network coverage (or be prepared to pay out of your own pocket) if your doctor leaves the network.
Fortunately, federal employees have help to answer their questions. The PlanSmartChoice online decision support tools are available free to all federal employees during the open season. In addition to PlanSmartChoice, organizations like OPM, Consumers Checkbook, and health plans also provide assistance. It’s also always a good idea to speak with a medical plan’s customer service department to confirm any specific issue before making a final decision.
Colleen M. Murphy is the President and CEO of Asparity Decision Solutions. Hundreds of thousands of federal employees have used PlanSmartChoice, the company’s decision support tools, to choose health insurance coverage.