What Should I Do When My Employer Changes Medical Plans?
You remember sitting through a presentation about your company health care plan, and you vaguely remember something about the plan changing from one insurance carrier to another. What difference does it make, anyway? You’ll still have insurance coverage, and that’s all you need to know, right?
Right -- as long as you don’t actually need to use your health care plan. The devil is in the details, as they say, and that includes when the old plan expires and the new plan takes effect. Switching from one insurance carrier to another can create a gap in coverage of at least a few days. And you may not receive your new medical cards until after the old plan ends. So it’s a good idea to plan ahead as much as possible to prevent having to deal with any potential interruption in coverage.
Fill drug prescriptions before the old plan runs out so you can be sure you are covered.
“We always tell our groups, especially if they’re going from one carrier to another, make sure you get your prescriptions before the end of the plan, so if you need something, you’re not scrambling, wondering ‘how am I going to get it?’ It never fails,” says Kuzneski Insurance Group Client Advisor Vickie Davidson. “Someone is going to have a doctor’s appointment, someone’s going to need a prescription. At that point the employee has to pay for that prescription, and then try to get reimbursed.”
If you are unable to refill a script in time, sometimes pharmacies will back-date a prescription to when the old plan was in effect, Vickie advises – though you shouldn’t count on that.
“We have noticed that sometimes when clients are moving from one carrier’s plan to another, sometimes the implementation doesn’t go as planned, or maybe it takes longer than normal” on the carrier’s end, says Melissa Craig, Benefits Advocate at KIG. “The client may not be in the system yet when the new plan starts. Then the subsequent bills have to be sorted out, which can be a hassle for both you and the insurance broker.”
Make sure medical appointments (dental and vision, too!) are scheduled well in advance so they occur after the new plan kicks in. Avoid scheduling appointments around the time your insurance plan is set to expire.
Of course, life happens, and you can’t always dictate when you’ll need to see a doctor – or go to the hospital for that matter. In those cases, you may very well be responsible for the charges, says Vickie. “But most hospitals have a plan to work with folks with no insurance where they can lower the cost.” For low-income patients, the hospital will often write off anywhere from 25% to 100% of the bill, Vickie says.
On a related note, you also want to make sure your primary care physician, dentist and eye doctor will accept your new medical insurance before the old plan expires. Simply call the doctor’s office and ask whether they accept that specific kind of insurance. If not, you’ll want to find a doctor that does accept the new insurance right away.
We know you have enough headaches to deal with (hopefully only figuratively speaking), and taking these steps before a new insurance plan goes into effect can help prevent further consternation. While we aren’t authorized to fix literal headaches, we can help alleviate figurative ones for our clients who run into a problem with a gap in health care coverage. Just give us a call!