When you choose among health plans (an open season opportunity is ongoing under the Federal Employees Health Benefits program and there are various other situations in which enrollment choices can be made at other times), here are some factors to consider:
- Maternity care. If you think you’ll be adding to your family, maternity care is especially important. Sign up with a plan that has obstetricians with whom you’re comfortable.
- Pediatric care. Find out about the pediatricians on the list if you have small children. Whether or not you’re expecting to have more children, you need to evaluate the care the kids you already have can expect to receive.
- Flexibility. Ask about a “point-of-service” option with an HMO–you’ll pay more but you’ll have some coverage if you see physicians who are not in the network.
- Locations. If you have to go to one central HMO office, find out if it’s convenient for you. Other HMOs use doctors who practice in their own offices, but make sure some of those physicians are near where you live or work.
- Travel coverage. If you or a family member is away from the plan’s service area, what coverage is provided other than for emergency or “urgently needed” services? Some plans arrange with plans in other areas to provide health care services to their members traveling through or visiting those areas.
- Reach. If your children are college students or future collegians, will the HMO provide coverage while they’re away at school? Ideally, your kids should be able to get emergency care, then file a claim with your HMO.
