THINGS TO CONSIDER WHEN BUYING HEALTH INSURANCE
Even though the health care reform law requires all health insurance carriers to cover the same basic benefits today, there are still key differences between health plans that you need to be aware of. Among them is network, prescription drug formulary, plan design and service.
It’s important to shop and compare these items when you’re choosing a health care plan. The process can be complicated, but our handy guide can help you make the right choice for you and your family. And if you ever have questions about Common Ground Healthcare Cooperative’s plans, our Sales department is here to help. Call them at 855.494.2667.
PPO VS. EPO VS. HMO
Common Ground Healthcare Cooperative individual and family plans are Exclusive Provider Organization (EPO) plans. This means that individual and families have in-network coverage with very limited out-of-network coverage including urgent care visits outside of our coverage area and emergencies. Small group plans are Preferred Provider Organization (PPO) plans, which means we cover some costs of out-of-network care. Many other plans are HMO (Health Management Organization) plans, which generally do not cover out of network care and may require you to choose a primary care doctor.
DOCTORS AND HOSPITALS
CGHC’s provider partners include: Aurora Health Care, Bellin Health Systems, ThedaCare, Children’s Hospital and Health System, Door County Medical Centers, and St. Joseph Hospital – Milwaukee Campus. With this provider network, you have access to high quality in-network healthcare coverage. You’ll save the most money when you choose in-network providers. Click here to see our provider directory so you can see which providers are in-network.
Common Ground Healthcare Cooperative’s drug “formulary” is a document that explains which medications we cover at what tiers. Our plans have four drug tiers, largely based on the cost of the medication. We have a generic drug tier (the least expensive, except for a handful of medications that we cover at no cost) and then a “preferred” tier, a “non-preferred” tier and then the most expensive medications fall in our “specialty” drug tier. Drug formularies are different from company to company,
In general, Common Ground Healthcare Cooperative will provide coverage for prescriptions regardless of which pharmacy you frequent. The only exception would be non-CGHC mail order and pharmacies outside the US.
Common Ground Healthcare Cooperative provides a convenient mail order prescription service that will fill your maintenance medications and mail them to your house for a lower copay.
The monthly cost – or premium – for your insurance policy is a very important consideration when choosing a plan. But you need to look at the benefits your policy provides as well.
TIERS OF COVERAGE
There are four categories – or metallic tiers – of health insurance plans. These categories reflect the amount of healthcare costs that will be covered by the plan. Bronze plans will cover the least amount of costs, while Platinum plans cover the most. Silver and gold are in the middle, with Gold covering more than Silver. Most people select Bronze or Silver plans.
COPAYS VS. COINSURANCE PLANS
Not all plans are the same. Costs and benefits can vary widely. When comparing plans, be sure to look at all costs, such as premiums, deductibles, co-pays and out-of-pocket maximums when choosing. CGHC and many other carriers offer plans with copays and without copays. Copay plans are generally more expensive from month to month, but they can help make the cost of healthcare more predictable. That’s because a copay is a set amount you will pay each time you visit your doctor or specialist, visit an urgent care or emergency room and fill most prescriptions. In our plans, copays apply before you meet your deductible (although this is different with some other companies’ plans).
Health Savings Account eligible health plans are health insurance products with a deductible that is high enough to qualify you for tax-advantaged savings on health expenses. To qualify as an HSA-eligible plan, the health plan can only pay for preventative care services and nothing else before the deductible is met.
Purchasing an HSA eligible health plan is just the first step in gaining tax-advantages when paying for medical expenses. The second step is to open an HSA account at your bank or credit union. Any money you put into your HSA account can be used to pay for deductibles, copays and out-of-pocket healthcare costs. The money deposited into an HSA account is not taxed at the time of deposit or upon withdrawal as long as you spend it on qualified medical expenses. It’s all documented on your tax return. Best of all, the money is yours to keep and rolls over from year to year. Learn more about HSA plans here.
You have quite a few options when it comes to choosing your health insurance company. Before you decide, learn more about us.
HEALTH INSURANCE THAT CARES ABOUT PEOPLE. NOT PROFIT.
As a nonprofit, member governed insurer, we believe in providing honest answers and support to our members. And because we are a cooperative, future profits are directed toward lower costs and improved services.
CALL US WITH YOUR QUESTONS
Members come first at our company. Our member services department is located in Brookfield, Wisconsin and is available to take your calls from 8:00 am to 5:00 pm Monday through Friday. You can talk to a Member Services representative by calling 877.514.2442. Or, if you are looking for insurance, you can contact our Sales Department at 855.494.2667.