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Decision Worksheet printer friendly version

What plan is best for me?
Build on your expectations and use information from Health Matters, your employer, the health plans, and other resources to decide about the health plan that is right for you and your family. Use this worksheet as your guide through these steps toward your health care decision!

• Set expectations
• Gather information
• Make a choice

Answer these questions!
Make notes as you need to! HMO POS PPO Indemnity


Write down the names of plans you have to choose from in the appropriate column.

name of plan(s)

____________

____________

name of plan(s)

____________

____________

name of plan(s)

____________

____________

name of plan(s)

____________

____________
0
Do I have a favorite physician or other provider?
If no, skip this question.
Are they in the network?

If yes, find out if they are in the network:

 Yes or No Yes or No Yes or No Yes or No

• see physician or plan website or call plan or doctor’s office
0
Do I have a hospital that I prefer?
If no, skip this question and the next question. Is the hospital in the network?
If yes, find out if the hospital is in the network:
 Yes or No Yes or No Yes or No Yes or No

• see hospital or health plan website
• call health plan or doctor’s office

0
Does the hospital I prefer participate in the Leapfrog initiative to improve safety?
Does the hospital participate?
  Yes or No Yes or No Yes or No Yes or No
0
Are the benefits I need covered?
Some plans do not cover or provide limited benefits for prescriptions, mental health treatment, hospice, medical equipment or preventive services. Yes or No Yes or No Yes or No Yes or No
  • read employer or plan documents
0
Does the plan have special services that I might need?
Examples are special programs for asthma, diabetes or other conditions. Yes or No Yes or No Yes or No Yes or No
  • read employer or plan documents
  • call health plan
        
0What premium cost will I have for the year?
$________/yr $________/yr $________/yr $________/yr
  • See rates filed for small businesses at: www.dora.state.co.us/Insurance/mainmenu/htm
  • read employer or plan documents
0
What out-of-pocket costs do I expect for next year?
Consider: inpatient, outpatient hospital, pharmacy and physician costs. If you take prescription drugs, compare the coverage and cost of these drugs in different plans. Each plan has a preferred drug list (called a formulary), and the cost of the drug depends on your company or the health plan's benefit design. coinsurance: $________/yr
copays:
$________/yr		 coinsurance: $________/yr
copays:
$________/yr		 deductible:
$________/yr
coinsurance:
$________/yr
copays:
$________/yr		 deductible:
$________/yr coinsurance: $________/yr
copays:
$________/yr
  • read employer or plan documents
  • call health plan
  • see health plan web site
0
What is a "worst case" for out-of-pocket costs, such as a major accident, surgery or cancer?

Consider inpatient, outpatient hospital, pharmacy and physician costs.

  • read employer or plan documents
 coinsurance: $________/yr
copays:
$________/yr		 coinsurance: $________/yr
copays:
$________/yr		 deductible:
$________/yr
coinsurance:
$________/yr
copays:
$________/yr		 deductible: $________/yr coinsurance: $________/yr
copays: $________/yr
0
Total expected costs for the year. $________/yr $________/yr $________/yr $________/yr
0
Total "worst case" costs for the year. $________/yr $________/yr $________/yr $________/yr
Now, consider more about quality health care!
Do I need information about this health plan’s complaint levels?
complaint ratio is: _________ complaint ratio is: _________ complaint ratio is: ________ complaint ratio is: _________
0
Does this kind of plan make efforts to improve health care quality?
name of plan name of plan may be
offered, often
at additional
cost, check
with plan		 may be offered, often at additional cost, check with plan
0
Does the plan I am considering meet accreditation quality standards?
  • see Accreditation
  • see www.ncqa,www. jcaho.org or www.urac.org.
  • call health plan
 name of plan name of plan not common,
call the plan
directly 		does not apply
0
How does the plan I am considering rank on customer satisfaction?
name of plan name of plan no data for
consumers to
compare 		no data for consumers to compare
0
How well does the health plan promote the best health care for my needs?
see Living with Illness & Staying Healthy name of plan name of plan no data for
consumers to
compare 		no data for consumers to compare
  • Keeping me healthy with cancer screening and prenatal care.

____________

___________
  • Managing mental health needs.
 _________ _________    
  • The best care for chronic conditions
 _________ __________
Make your choice!
Consider the options, your preferences, and your costs.
Which plan offers the most for you? ____________ ____________ __________ ____________
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