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Choose the Best Option for You and Your Family

This is the time of year when many companies offer open enrollment periods for their group health insurance plans. Insurance Superintendent Eric Dinallo urged New Yorkers to carefully consider all of their options to select the program that best meets their needs.

“Open enrollment is when all members of a group health insurance plan are able to enroll in certain benefit programs or switch to another benefit plan offered by their employer. During open enrollment, insurance carriers are required to accept all applicants of a group,” Dinallo said.

“Open enrollment is generally held once a year. If you miss your company’s annual open enrollment, you likely will not be able to enroll or switch coverage until the next open enrollment period. Certain exceptions apply for new employees or employees with life-changing events,” he said.

Dinallo offered these tips when considering insurance options:

Read and Understand the Materials

There are different types of major medical plans typically offered by employers. These include preferred provider organizations (PPO), health maintenance organizations (HMO), point-of-service plans (POS), or indemnity plans. Plan materials provided by your employer will detail the coverage, including the amount of co-pays, co-insurance and deductibles, as well as which medical providers are in-network. This information will also include exclusions and policy limits.

Do Your Homework

Before making a choice, see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save you money. Also, see if spouses and/or dependents are covered. Some plans will cover them, while others will not. Read all of the plan materials thoroughly to understand your rights and responsibilities.

Compare Costs and Coverage Features

It’s important to carefully evaluate your health care costs. One option might have high monthly premiums and a low deductible. Another option might have a low premium but more out-of-pocket expenses. Calculate which option is most cost effective.

To pick the best coverage, first calculate your health care costs from recent years and estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures you might be planning. Next, make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional charges for wellness care or specialists are examples of out-of-pocket expenses you will be responsible to pay.

If any part of the health care plan is unclear to you, ask for help from your company’s plan administrator or the insurance carrier. If you still need help, contact the New York State Insurance Department between 9 a.m. and 4:30 p.m., Monday through Friday toll-free at 800-342-3736, or review health insurance information on the Department’s website,


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