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Selecting a Health Plan

Last Updated 11/20/2008

Choosing your health insurance plan is an important decision. Although El Camino Hospital cannot advise you of which health insurance plan to choose, our Contracting Services department recommends you consider taking the following steps before making your decision:

Step 1
Visit the health insurance company website. Review the data including the physician directory and that the services you are currently receiving to verify that they are covered by the health plan and health plan type (PPO, HMO, EPO, etc.)

Note:  As of October 1, 2013, individuals and families may purchase private health insurance through the healthcare exchange marketplace. To learn more about your options, please visit Covered California.

Step 2
(a) Telephone your physician's office and ask if they accept your health insurance and the type of product, i.e., PPO, HMO, EPO, etc., you are considering.

(b) Telephone the health insurance company and speak to a customer service representative, who should have the most up-to-date information. Ask if your primary care physician(s) and specialist(s) have contracts with them. Since health insurance companies offer several products (PPO, HMO, EPO, etc.), ask which products your primary care physician and/or specialist is contracted under.

Step 3
Check to see if your prescription medications are on the plan's formulary.

Other items to consider:

  • What are the out-of-pocket expenses?
  • What are the co-pays and deductibles?
  • What are the co-pays for emergency room services?
  • Are any education and/or support group programs included or reimbursable?

Insurance Counseling at the Health Library & Resource Center
El Camino Hospital's Health Insurance Counseling Program is a free service designed to answer questions and concerns about medical bills or insurance coverage. The program counselors offer one-on-one assistance to help answer your questions and offer advice to solve specific health insurance issues. To schedule an appointment for your free health insurance consultation please call the Health Library & Resource Center at 650-940-7210.

On-line Resources
The Agency for Healthcare Research and Quality (AHRQ) is the Nation's leading Federal agency for research on healthcare quality, costs, outcomes and patient safety. Its website includes a section on how to select a health plan. You may also want to visit your company's intranet or human resources department for more information about your health insurance options.