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Most important aspects to look for in isurance policy?
Feb 13, 2008

What are the most important aspects of an insurance coverage an HIV+ patient should consider when shopping for an individual insurance plan policy. I don't mean the type of coverage (such as HMO vs PPO), but what aspects of a particular policy (such as prescription benefits, lifetime maximums, yearly deductibles, etc.) should an HIV+ individual consider most important when shopping for their insurance. The results of the HIV test were received anonymously, so considering the condition as preexisting should not be an issue. Also, in California, it appears a health insurance companies (unlike life insurance or disability insurance companies) cannot request an HIV test as a condition of underwriting/issuing a policy. Any recommendations/information you may offer would be most appreciated as I am a novice in this area and I have no idea who to turn to for this information. Thank you very, very much for your assistance.

Response from Ms. Franzoi

The key things to look for would include: 1. How prescrition drug coverages are handled - co-pays, open or closed formulary, annual or lifetime maximums (if any) and out-of-pocket limits. 2. If it is a PPO, an HMO or a POS, who are the providers in-network? What happens if you go out of network? 3. What are the plan's lifetime maximums? Are there separate deductibles, out-of-pocket maximums and lifetime maximums for prescription v. medial claims? 4. What are plan's exclusion?



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