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Health Insurance

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Before accepting a new job, it is always important to inquire about and negotiate, what your health care benefits will be once you clear any probationary periods prior to your coverage kicking in. Assuming full employment will automatically yield full health care coverage for you, and your loved ones, may possibly lead to a rude awakening once you have to seek some medical care. Additionally, as rules change regarding what employers have to offer to employees, and as doctors and health care facilities change networks, it is not uncommon to be caught on the wrong side of health care rules and expenses.

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I have heard numerous stories surrounding not only the high costs some families pay for health insurance, but also the pure shock and sorrow of learning that their health insurance will not cover their children. A friend just recently shared with me that her employer has offered full healthcare coverage for her since she has been employed with them for well over 15 years. While she was pregnant, her insurance continued to cover her maternity healthcare costs, inclusive of delivery.

However, what she did not know, until she was about to bring her infant home from the hospital, was that her company only offered coverage to her, and not any other family member. She was left with a potential monthly charge of close to $900 a month, just for her child. After some negotiation with her company, they agreed to pay a portion of that fee, but being caught off guard with unexpected health care costs, can be totally avoided.

As mentioned by Kaiser Family Foundation, here are six questions to ask yourself every year as it relates to your health care to ensure you are prepared for impending costs and are not caught off guard.

1. Is my doctor still in the network?

Some employers are shifting to plans that look like the HMOs of the 1990s, with limited networks of physicians and hospitals. Provider affiliations change even when companies don’t adopt a “narrow network.”

2. Is my employer changing where I get labs and medications?

For expensive treatments — for diseases such as cancer or multiple sclerosis — some companies are hiring preferred vendors. Getting infusions or prescriptions outside this network could cost thousands extra, just as with doctors and hospitals.

3. How will my out-of-pocket costs go up?

It’s probably not a question of if. Shifting medical expense to workers benefits employers because it means they absorb less of a plan’s overall cost increases.

Your company is probably raising deductibles — the amount you pay for care before your insurance kicks in. The average deductible for a single worker rose to $1,217 this year, according to the Kaiser Family Foundation.

4. How do I compare medical prices and quality?

Companies concede they can’t push workers to shop around without giving information on prices and quality.

Tools to comparison shop are often primitive. But you should take advantage of whatever resources, usually an online app from the insurance company, are available.

5. Can I use tax-free money for out-of-pocket payments?

Workers are familiar with flexible spending accounts (which aren’t that flexible). You contribute pretax dollars and then have to spend them on medical costs before a certain time.

Employers increasingly offer health savings accounts, which have more options. Contribution limits for HSAs are higher. Employers often chip in. There is no deadline to spend the money, and you keep it if you quit the company. So you can let it build up if you stay healthy.

Don’t necessarily think of HSAs as money down the drain. Think of them as a different kind of retirement savings plan.

6. How is my prescription plan set up?

Drugs are one of the fastest-rising medical costs. To try to control them, employers are splitting pharma benefits into more layers than ever before. Cost-sharing is lowest for drugs listed in formulary’s bottom tiers – usually cheap generics — and highest for specialty drugs and biologics.

If you’re on a long-term prescription, check how it’s covered so you know how much to put in the savings account to pay for it. Also see if a less-expensive drug will deliver the same benefit.

Rashida Maples, Esq. is Founder and Managing Partner of J. Maples & Associates (www.jmaplesandassociates.com . She has practiced Entertainment, Real Estate and Small Business Law for 10 years, handling both transactional and litigation matters. Her clients include R&B Artists Bilal and Olivia, NFL Superstar Ray Lewis, Fashion Powerhouse Harlem’s Fashion Row and Hirschfeld Properties, LLC.

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