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?