| What's a "gotcha" provision? |
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If you're like most health shoppers, you are you looking for a new health plan with affordable premiums and a clear explanation of your coverage. You may also want to see some payback for all of those premium payments if you rarely see a doctor, or if you do see a doctor periodically or often, you want a plan that works best for your situation. But, what if you end up in the hospital and then find out your plan has a "gotcha" provision? I consider a "gotcha" provision to be any feature of a health plan that gives you an unexpected, negative surprise (i.e. a bill) after a visit to the doctor or to the hospital. These "gotcha" provisions are simply cost share mechanisms, or a way of shifting medical expenses from the insurance company to the policy holder. Examples include facility fees, brand name drug deductibles, outpatient surgery maximums, etc. "Gotcha" provisions do serve a purpose, however. With medical costs spiraling upwards at a rate of 10% - 20% annually, insurers need to find ways to share medical expenses in order to keep premiums affordable. Without cost sharing, your premiums would easily be in the thousands of dollars per month. But what does this mean for you? Cost sharing features are in every commercial and government sponsored health plan today. The best way to deal with them is to fully understand where cost sharing takes place, and to minimize the impact of the "gotcha" provisions in your plan while also keeping the premiums within your budget. In other words, don't be penny wise on premiums and pound foolish on benefits. This is also an area where I can help. I will work with you and/or your family to identify your needs in a health plan. By working together, you can either understand how a gotcha provision will affect you, or you can steer clear of them. I will also try as best as possible to keep you under your monthly budget for health insurance.
Copyright: BenefitRiver Health Insurance, Golden, Colorado
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