Health Plan Comparison Form Page 2
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42.
Things to consider
Do I have to take a health questionnaire
Yes
No
Yes
No
to get the plan?
Do ALL my providers (doctors, hospitals,
specialists, pharmacies, etc.) take this
Yes
No
Yes
No
plan? (Look on the company’s website or
call)
Do I need referrals for specialists?
Yes
No
Yes
No
Does this plan accept provider billing or
Accept
Accept
do I have to pay upfront and get the plan
Pay up front
Pay up front
to reimburse me?
If I have a pre-existing condition, how long
will I have to wait for coverage?
3.
Coverage
This plan covers these services
(Covered services) that are important to
me:
Note: Include coverage for any family
members. Check for services you and your
family use now or plan to use, including
prescriptions, maternity, etc.
This plan does NOT cover these services
(Excluded services) that are important to
me:
Note: Include coverage for any family
members. Check for services you and your
family use now or plan to use, including
prescriptions, maternity, etc.
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