Health insurance can be confusing, but knowing your options is an important part of taking charge of your health and the health of your family.
Many people access health insurance through their employer (or their partner’s employer). Some employers offer plans from a variety of insurance companies; some offer plans only from a single insurer. Knowing what your choices are is the first step to making an informed decision about your health care.
How do I know whether I have a choice in health insurance options?
You can determine whether your employer (or your partner’s) offers a choice in health insurance plans in several ways, depending upon how your organization operates.
You may receive a booklet from your human resources group that outlines your benefits, including health insurance options. Or this information may be documented and updated periodically in a comprehensive employee handbook, delivered in hard copy or available electronically.
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You may be asked to review your health insurance information every year during your company’s “open enrollment” period — a good time to check on the choices available.
Or, your elections may roll over from year to year unless you contact your human resources group to request or inquire about changes.
If you’re still unsure, reach out to your human resources group. You may want to discuss whom to reach out to with your direct supervisor first.
Why would I want to choose a different health insurance option?
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Your health and the health of your family is important, and the health insurance plan you choose can affect every aspect of your wellbeing and access to care. Examine your options carefully, and consider the following questions:
- Does this plan provide in-network access to my primary care provider?
- Does it provide in-network access to my kids’ pediatrician?
- Does it provide full, in-network to my preferred hospital, or the hospital closest to me, in case I need to be admitted or observed or schedule a surgery or procedure?
- Does it provide full, in-network access to the sort of specialty care I or my loved ones may need, including:
- How far would I need to travel, or what are my options, if these services aren’t in-network under my insurance plan?
Why wouldn’t my employer offer choices in health insurance plans?
Every company is different, with different goals and resources — just like every family is different. Changing or adding health insurance plans is driven by many things, including:
- Access—what does the insurance plan provide in terms of access for employees?
- Cost—both to the employer and passed along to the employee
- Legacy—your company and the insurer have worked together for many years
Not every company can offer plans from more than one insurance company, so it’s important to understand what benefits are offered and if they meet your family’s needs.
How do I go about asking my employer to switch insurance plans or offer a choice in health insurance?
That depends on your company. In some organizations (particularly larger companies), an intranet or other online internal communication structure includes forms or surveys that make it easy to communicate your feedback, including the changes you’d like to see.
Other companies may traditionally use email to communicate benefits information to employees. In smaller companies, you may want to schedule some time to meet with your supervisor or a human resources leader to discuss your concerns and needs. Think about how your company usually shares information and conducts communications, and proceed accordingly.
What can I say about why I need a choice in health insurance options?
You may want to note your concern about your doctor (or a doctor you would like to see) not being in–network under your company’s insurance plan. You may also want to explain why the plan doesn’t serve your family’s needs. Perhaps you have a condition that requires ongoing management or advanced care, and you’re concerned about the care available from in-network providers under your company’s current plan.
There’s no need to reveal personal details unless you feel comfortable sharing them. This is an opportunity to explain the ways in which the insurance plan doesn’t address your concerns and then ask for a choice.
Asking for more choices doesn’t have to be difficult. Your health matters, and voicing your concerns about your access to the best insurance plan for you is a way to make sure you’re taking care of yourself and your family.
A $21 billion health care provider and insurer, Pittsburgh-based UPMC is inventing new models of patient-centered, cost-effective, accountable care. The largest nongovernmental employer in Pennsylvania, UPMC integrates more than 90,000 employees, 40 hospitals, 700 doctors’ offices and outpatient sites, and a 3.8 million-member Insurance Services Division, the largest medical insurer in western Pennsylvania. In the most recent fiscal year, UPMC contributed $1.4 billion in benefits to its communities, including more care to the region’s most vulnerable citizens than any other health care institution, and paid more than $500 million in federal, state, and local taxes. Working in close collaboration with the University of Pittsburgh Schools of the Health Sciences, UPMC shares its clinical, managerial, and technological skills worldwide through its innovation and commercialization arm, UPMC Enterprises, and through UPMC International. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside on its annual Honor Roll of America’s Best Hospitals and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. For more information, go to UPMC.com.