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'The Business of Health Care Report'

It’s Open Enrollment Time: What You Should Know About Choosing a Health Plan
10/24/2005

I’m Doug Hawthorne, president and CEO of Texas Health Resources, with “The Business of Health Care Report.”

Those of us who have employer-based health coverage know that the fall typically means open enrollment time. With Texas having the highest percentage of uninsured residents in the nation, it’s vitally important that those of us who can afford health insurance do what it takes to get it.

If you’re evaluating health insurance options, consider these points.

First, does the plan meet your needs? For example, if you’re young and healthy, you should at least consider a higher-deductible plan with more out-of-pocket expense. Generally, that will give you a lower premium but still protect you from catastrophic financial burdens if you’re sick or injured.

Regardless of the plan, pay attention to deductibles, co-pays, annual out-of-pocket maximums and lifetime benefits. Make sure you know what the plan pays for office visits, tests, hospitalizations and prescription drugs.

Second, review the plan’s network of providers. If the physicians and hospitals you prefer are not in the network, this could result in higher out-of-pocket costs. Also, does the plan provide out-of-network coverage? Without it, you could be responsible for the entire bill.

Third, check if your employer offers wellness programs that encourage healthy lifestyles and prudent health care spending.

When unsure about health care options, your employer’s benefits counselors can help. Visit TexasHealth.org for additional resources.

For Texas Health Resources and its faith-based hospitals – Harris Methodist, Presbyterian and Arlington Memorial – I’m Doug Hawthorne.

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