F. Questions to Ask Regarding Employer-Provided Health Benefits

• How much is your monthly premium? Is this taken directly out of your paycheck? Are you allowed to pay more on your own to get better coverage or shift your money to a more cost-effective plan?
• Does the company have a summary plan of benefits? If so, read the summary to get a better idea of the basic benefits offered. (Note: It may still be necessary to read the entire plan to get more specific information and check the fine print.)
• What are the plan's exclusions and limitations? What mental and physical conditions does the plan not cover?
• Does the plan cover preexisting conditions?
• How much is your annual deductible (the amount you must pay before your insurance kicks in)?
• What is the process for filing claims? Do you have to pay and submit proof of payment before reimbursement, or can you submit claims directly from your physician? How long must you wait before reimbursement?
• Can you appeal a negative decision not to be reimbursed? If so, what is the process for filing an appeal?
• Does the plan pay for second opinions and preventive tests such as mammograms and Pap smears?
• If you are close to retirement age, what impact will Medicaid and Medicare coverage have on your benefits?
• Does medical, dental, and hospitalization coverage stop the day you are fired or resign, or is there a grace period (e.g., through the end of the month)?
• Can you extend coverage beyond the grace period?
• Can you assume any group health policy (this is sometimes referred to as a conversion policy)?

If you discover that the health benefits your employer is providing are not substantial, consider implementing coverage through your spouse's coverage or purchasing coverage from additional plans.