After four years in the health insurance business I have learned to read the fine print. Health insurance is like a can of fruit cocktail; the essential elements might be in the package but the manufacturer might be adding something you don’t want. Never trust the marketing of any insurance product because they always over promise and under deliver just like when the can says no sugar added.
Check the ingredients of your health plan before you renew
I love fruit cocktail as part of my breakfast. I like to add seasonal fruit such as strawberries and blue berries into the mix. When I saw a can of fruit cocktail that said No Sugar added, I decided to try it. It tasted better. Then I put on my glasses on and read the fine print – “artificially sweetened”. How and why would fruit cocktail be artificially sweetened with sucralose? As an informed consumer I bought into the marketing promise of no sugar added and failed to see the artificial sweetener sucralose had been added.
Summary of Benefits will describe the ingredients
Health insurance and health plans employ similar marketing promises. While all the marketing slogans suggest you will thrive under their health plan or they help you when you are sick and get healthy, it’s important to read the ingredients of any health plan before you enroll or renew the health insurance. Just as you would read the nutritional label on the side of a can of fruit cocktail, you can see what is included in a health plan by reading the Summary of Benefits and Coverage.
Fruit cocktail labels have more information than health plans
The list of ingredients on a can of fruit cocktail is actually more illuminating about the product than many of documents supplied by a health plan. From the fruit can I learned that some of the pineapples and cherries actually came from the Philippines, Chile and Bulgaria. When you look at the Summary of Benefits for a health plan they never tell you which doctors, medical groups, hospitals or other providers are in the network. Aren’t the providers essentially the cherries, grapes and pineapples of the fruit cocktail of a health plan you purchased?
What’s an aggregate deductible?
The fine print of the Summary of benefits will describe the difference between an aggregate and individual embedded deductible. (See: Aggregate deductible of HSA plans) Lost in the translation is the reality that with an aggregate deductible the family deductible must be met before the coinsurance applies. This means in a family of four, a sick child must meet the family deductible, not the individual embedded deductible amount like other plans, before the coinsurance starts to lower the health care expenses.
In, Out or NO network coverage
Other terms such as PPO, and its respective accumulation of health care expenses toward the “in-network” and “non-network” deductible, is also somewhat fuzzy in the fine print. The lower deductible of the HSA (Health Savings Account) plans seems appealing until you learn the meaning of aggregate deductible. The Exclusive Provider Organization, alternately known as a Tiered Network or EPO, has a similarly cloudy definition. The bottom line is that there is no out-of-network coverage under an EPO. (See: What’s best – PPO, EPO, HMO, HSP?)
Are your providers imported like cherries from Bulgaria?
Just like the fruit cocktail producer may add, subtract or procure the ingredients from another part of the world, health plans can change from year to year. Health insurance companies can decide to include or exclude certain doctors and hospitals. They can subtly change the health plan to make it more restrictive for receiving care or authorizing care in the Evidence of Coverage. Some of this information is darn hard to come by.
Don’t renew until you can find out what’s in the new health plan
Before you automatically renew your Covered California health plan, do as much research on what the ingredients of the new health plan. Is it the same as last year or have they made little changes to the ingredients to fatten their bottom line. As of this blog post, October 24, 2014, very few of the health plans have released their Summary of Benefits or Evidence of Coverage for their 2015. We cannot depend on Covered California for accurate information because one plan, Health Net, has already changed their offerings in Southern California and this change is not reflect on any Covered California literature.
Has your health plan been artificially sweetened?
Do yourself a favor and wait as long as possible before you renew. You have until December 15th to renew your current health plan or enroll in a new one for an effective date of January 1, 2015. You might save yourself a lot of grief if you can wait until the health plans publish more of the ingredients in their health plan before you renew. Just because it says no sugar added, doesn’t mean they didn’t artificially sweeten the product for marketing purposes.