Questions to Ask Your Insurer

Whether you are seeking new insurance or just trying to understand your existing policy, here are some questions you might want to ask.

• Will my policy cover my chronic condition/illness?
• Does it cover the prescription drugs and treatments for my chronic illness or condition?
• Are my prescription drugs on the formulary (drug list)? If not, what’s the cost difference and process for me to get them?
• Does my policy cover dependents or my spouse/domestic partner? Until what age or event?
• Is there a waiting period (pre-existing condition) before my condition or illness will be covered and services paid for? If so, can it be waived?
• Is home service covered? Are nursing services and supplies associated with infusion covered?
• Does my policy allow me to use both an “in-network” and “out-of-network” provider, physician, and pharmacy? If so, what are the differences in cost?
• Does my specialty pharmacy have experience providing services to people with chronic conditions/illnesses?
• Which hospitals and emergency rooms are covered?
• Are there any annual dollar limits for my care?
• Is the cost of IgG treatment a major medical benefit or pharmacy benefit? If it’s a pharmacy benefit, does that have any annual limits?
• Will my policy have a deductible? How much?
• Is there a specified “out-of-pocket” amount? How much?
• Is authorization/pre-certification required for medical services/procedures?
• Will the company inform me in writing of any changes to my policy?
• Can I have a summary of benefits PRIOR to purchasing/enrolling so I have all this in writing?
• Are we covered away from home (vacation, business trip, etc.)?
• Is there a lifetime maximum on any benefits?
• Will my policy coordinate benefits with another plan that my spouse/domestic partner or I have?

Download and Print Questions to Ask Your Insurer

Source: Adapted from Frequently Asked Questions page. Patient Services Advocate website. Available at http://uneedpsi.org?CMS400Min/about/index.aspx?id=60&ekmensel=77931891_34_0_60_3. Accessed April 10, 2009.