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Chooseing a health plan

You've just changed jobs, or your boss has announced changes in the health plans available to employees. How do you choose the health plan that's right for you? John Trezona, president of Premier Medical Consultants in Largo, offers these tips:

1. If your choice is between a health maintenance organization and a traditional indemnity health insurance plan, your first decision is whether cost is more important to you than choice.

2. Traditional insurance costs more but gives you greater say in what providers and treatments you can use.

3. HMOs will cost less but restrict you to the doctors, hospitals and treatments you can use if you want their insurance to cover your costs.

4. If choosing among HMOs, find out which plans offer the doctor and hospital that you prefer or that are closest to you. Each HMO publishes a list of providers it contracts with. Those lists can be at least 6 months old or more, so call the doctor and hospital to ask if they're still with that HMO and whether they intend to stay with it.

6. If you use the services of a specialist, such as a cardiologist, find out whether the HMO requires you to see a primary care doctor before you can get an appointment with the specialist. This gatekeeper arrangement can make your medical care more complicated.

7. Find out what you can about the HMO's reputation for medical care. Ask other people who use that HMO.

8. Be sure to review the literature from each plan explaining what benefits are offered and the grievance procedures for resolving complaints.

9. Ask your employer if the health insurer has any information on employee satisfaction with its health plans or on complaints about them.

10. Florida's Agency for Health Care Administration monitors HMO quality of care and has a hot line for complaints ((888) 419-3456). Check with that agency to see what record the health plans offered by your employer have.

- Ten Tips, compiled by Times correspondent Linda Gibson, offers advice on managing and spending money.

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