What does the plan pay for and what does it exclude?

Look for benefits such as:

• Preventive care
• Well-baby care
• Substance abuse
• Organ transplants
• Maternity care
• Chiropractic care
• Naturopathic care
• Mental health care

Find out how the plan works

Ask:

• Do you have a copay?
• How much is the deductible?
• How often will you have to pay the copayments or deductibles (per year, per occurrence)?
• Are there limits on the number of times you can receive a service (lifetime maximums, daily, or annual benefit caps)?
• Does the plan cover prescriptions?
• Are your prescriptions on the list of covered drugs (this is generally called the "formulary" list)?
• Can you see your provider?

Ask if there are special requirements to get your care covered

For example:

• Do you need prior authorization for some services? If so, how do you get authorization?
• Are there waiting periods before coverage takes effect?
• Are some types of care excluded?

To help you compare plans, use our Plan comparison form (PDF, 163KB)

Updated 01/18/2013