Director's Message

Director's Message

Choosing a health insurance plan

Choosing a health insurance plan can be overwhelming. Unfortunately, selecting the wrong plan can also be a huge financial pitfall. One common mistake is considering only the monthly premium. Although this must be taken into account, it should not be the only deciding factor. Remember, the cheapest premium may not be the best option, and could cost you more in the long run. When deciding which plan is best for you, there are many things to keep in mind.

Let’s talk about the basics of choosing the right health plan.

Provider network benefits

All plans are not set up the same. Depending on the insurance, you may be limited to using only in-network or certain providers and facilities, or you may receive a greater discount when choosing within a certain network. Understandably, it is not always comfortable to start over with a new provider or to make a change, so it is very important to understand your options.

Some questions to consider:

Out-of-pocket expenses

If applicable, make sure to look at the following elements: deductible, coinsurance, copayments and catastrophic maximums. A deductible is a fixed amount of covered expenses you must incur for services and supplies before the insurer will start paying benefits. The coinsurance is the percentage of the bill that you will be responsible for after your deductible has been met. A copayment is a fixed amount of money you pay to the provider, facility, pharmacy, etc., when you receive certain services. The catastrophic out-of-pocket (OOP) maximum is a protection that limits how much you will have to pay in a calendar year. Keep in mind that all expenses may not count toward the catastrophic OOP maximum limit, and each plan may have different guidelines. With all this information in mind, you can compare costs of each insurer by considering how often you normally see a medical provider, visit a medical specialist, or need care at a facility.

I recommend you also review your current health and determine if you have any medical conditions that might require more care in the future, and also plan for the unexpected. Unexpected costs are those associated with emergency room care, surgical procedures and hospital coverage, both inpatient and outpatient.

You also should pay special attention to the insurer’s prescription program. Determine whether the plan offers a formulary drug list, or lists each drug into tiers, which will determine the level of cost you will pay.

Lastly, think about what extra programs or benefits are especially important to you. As every insurer is different, you may encounter benefits that are not covered by some plans or have a limited coverage. You also may find that some insurers have programs that others may not.

Dare to compare

You can compare up to four plans at opm.gov/insure. Type in the URL, then click on “Compare Health Plans” under the “Quick links” section. Insert your ZIP code, employee type and pay frequency. After the information is entered, you will be able to select which plans are of interest and review an overview of benefits. Remember, the 2021 benefits have not yet been posted at this time but will be available closer to the official Open Season.

NALC Health Benefit Plan

In closing, I encourage you to look at the NALC Health Benefit Plan when reviewing your options. We have three plan options to choose from, and I believe you will find that our benefits and premiums remain competitive in an everchanging health world. You can find information on our website at nalchbp.org, or by calling one of our customer service representatives at 888-636-6252.

Upgrade your health to a union that delivers!

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Note: The information located in this article is only a summary of some of the NALC Health Benefit Plan benefits.  Detailed information can be found in the NALC Health Benefit Plan's official brochure (RI 71-009).  All benefits are subject to the definitions, limitations, and exclusions set forth in the official brochure.