Health Insurance Values » HealthLog with Dave Keller

Health plan stress test

Lately there has been a great deal of focus on the stress test concept designed to gauge the health of the U.S. banking system. People with individual health insurance plans should also perform a stress test of sorts to determine if their health plan will cover what they need in time of a serious illness.

Test #1
Does your plan cover hospital-based physicians, such as anesthesiologists and radiologists, who treat you at a network hospital but do not belong to a PPO network themselves? Some health plans consider these non-participating, hospital-based physicians to be out-of-network, even though they work at participating hospitals. Since you cannot choose your anesthesiologist or radiologist, you may have to pay thousands of dollars directly out of your pocket at claim time. Check your health plan to see how it treats “forced providers.”

Test #2
Do you have critical illness coverage? Critical illness (CI) coverage pays you a lump-sum benefit at the time of diagnosis for a covered illness. The payment varies based on the plan selected, but is generally between $2,500 and $10,000. Since the money is paid directly to the insured person, it can be used for any type of bill, from medical bills charged to deductible and out-of-pocket limits to a mortgage payment.

The median total out-of-pocket treatment cost for breast cancer patients was $2,616, according to a recent American Cancer Society analysis. When you add on the cost of lost wages, travel to physician appointments and other expenses, the cost can easily top $5,000. Critical illness coverage can help make ends meet.

Test #3
How are pre-existing conditions covered? Some plans waive the pre-existing condition period for health conditions that are fully disclosed during the underwriting process. If you choose a plan that does not waive disclosed pre-existing condition periods, make sure you know the length of the pre-existing period.

Knowing how you will be covered in the event of a serious illness or injury is key to your financial planning — and giving your health plan a quick stress test is a first step in that planning.