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    Checklist

    Fill out the following checklist to evaluate your current health plan, as well as others you're considering. Compare the services offered against the cost of each plan. Then choose the plan that best meets your family's needs.

    Financial Considerations
    What is the monthly premium?

    ________

    What is the deductible?

    ________

    How much is the co-payment?

    ________

    What is the co-insurance percentage?

    ________

    Will you have a claim form to complete?

    ________

    Choosing a Provider
    Given the plan's participating providers, who would you chose for:

    a primary care physician

    ___________________________________

    specialists

    ___________________________________

    an urgent care center

    ___________________________________

    a hospital

    ___________________________________


    Evaluating Your Coverage
    Which of the following coverage is offered and how would you evaluate it -- good, fair, or poor:

    ________ Treatment of chronic conditions

    ________ Treatment of pre-existing conditions

    ________ Surgical care

    ________ Emergency room visits

    ________ Inpatient hospital services

    ________ Consultations with specialists

    ________ Family planning services

    ________ Maternity services, including prenatal care and delivery

    ________ Newborn care

    ________ X-ray and laboratory services

    ________ Rehabilitation services, including physical, speech and occupational therapy

    ________ Well-child care

    ________ Annual physical exams

    ________ Immunizations or allergy injections

    ________ Home health care or services of a licensed private duty nurse

    ________ Hospice care for the terminally ill

    ________ Care delivered at a skilled nursing facility instead of a hospital

    ________ Psychiatric care

    ________ Drug and alcohol treatment

    ________ Prescription drugs

    ________ Rental or purchase of medical equipment (such as crutches or a wheelchair)


    This information is provided for informational purposes only. Your decision regarding health insurance should be based on your particular situation. If you need advice, you should contact your insurance advisor. Copyright 1996, Sutter Health