Pick the right healthcare plan for you

Healthcare terminology | Pick the right plan | Questions or Problems?

Colorado WINS members secured millions in additional funding to fully cover Health/Life/Dental premium increases.

Use the resources provided on this page to better understand your healthcare options and make the decision that’s right for you and your family.

Healthcare terminology

Here are a few widely used terms you should be familiar with. Our definitions are based on those provided by DPA in their April 2012 Healthline newsletter. You can find an archive of the Healthline newsletters here.

Co-insurance – A percentage of costs for covered services that the insurance company pays after a deductible is met.

Co-pay – A flat fee that is paid for health care services at the time service is provided. Co-payments are specific amounts, which is convenient in planning for the cost of care.

Deductible – An amount an individual must pay for covered health care expenses before insurance begins to cover costs. Deductibles in health insurance work the same as deductibles in auto or home owner’s insurance.

Out-of-pocket maximum – The maximum amount of money a person will pay for covered health claims, which is in addition to premium payments. These maximums are usually the sum of deductibles and co-insurance payments or the sum of all co-payments.

Pick the right plan

The plan with the lowest premium may not be the best plan for you. If you have chronic conditions or expect to see a doctor more than usual this year, you may want to consider other factors, besides just the monthly premium cost.

How do you know which plan is best for you? Here are a couple articles to help you decide.

5 Tips for Choosing the Right Health Plan (Lisa Zamosky, WebMD.com)

  1. Pay now or pay later? Generally people with fewer medical needs can save money by paying a lower monthly premium and socking away the difference into a tax-free health savings account like an HSA or HRA.
  2. Do your math. Consider the types of medical care you typically need, the number of times you see the doctor in a given year, and how many prescription medications you take.  Calculate all out-of-pocket costs associated with those services, including deductibles, co-pays, and co-insurance. Then add that number to the cost of your insurance premiums. That’s a good estimate of what the plan will cost you next year.
  3. Plan for your worst-case scenario. Look beyond the medical services you expect to use and consider how well your plan would cover you if an unexpected illness hits.
  4. Are you in or out? Don’t forget to confirm that your doctors are included in a plan’s network of health care providers.
  5. Choose to be “well”. Many employers offer discounts on the cost of health insurance for employees who take an active role in the company’s wellness programs (in fact, Colorado WINS is currently working with DPA to establish a wellness program for state employees).

8 Keys to Picking the Best Individual Health Insurance Policy (Megan Johnson and Steve Sternberg, US News & World Report)

We have picked a few choice points, but you can read the full article for more information.

  1. Identify the “must-haves.” You can’t foresee a sudden injury or illness, but some medical needs can be anticipated. If you have a family history of heart disease, you may want to make sure your coverage includes the cost of cardiac screening tests and cholesterol-lowering drugs.
  2. Know your share of the costs. Plans are required to state how much you’ll pay out of pocket, a form of “cost-sharing” in which you pay a percentage of a medical service. When you’re sick, seemingly small copays can add up. And an expensive procedure could leave you obligated to pay thousands in coinsurance.
  3. Factor in your dependents. If you have children under age 26 without health insurance coverage through an employer, the law permits them to be on your insurance.
  4. Walk through several plans. It only takes a few minutes to review the main benefits associated with each plan, and some plans that look appealing at first glance may turn out to have cost-sharing features that could burden you with heavy medical costs.
  5. Read the entire article for more tips.

Questions or Problems?

If you have questions about the medical and dental plans (covered procedures, prescriptions, doctors, etc.) offered by the state contact the carriers or plan administrator directly.

Dept. of Personnel and AdministrationState_Benefits@state.co.us

United Healthcare — 1.877.283.5424, welcometouhc.com/colorado (a pre-member site) or myuhc.com (a member site requiring a username and password)

Kaiser Permanentekp.org or 303.338.3800 or 1.800.632.9700 (Denver/Boulder & Northern Colorado) or 888.681.7878 (Southern Colorado)

Delta Dental — 1.800.610.020 or deltadentalco.com

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