General Considerations about Choosing an Insurance Plan
When you choose a plan, you will undoubtedly have to make a few concessions. You may pay a little more out-of-pocket to have more physician flexibility or scope of coverage. Or perhaps you'll give up a few plan benefits in order to enjoy a lower monthly premium or smaller co-pay. The information below provides a quick background on health insurance. Keep these facts in mind.

Preferred Provider Organizations (PPOs)
A PPO has arrangements with a network of doctors, hospitals, and other providers who have agreed to accept lower fees from the insurer for their services. As a result, your cost sharing should be lower than if you go outside the network. In addition to the PPO doctors making referrals, plan members can refer themselves to other doctors, including ones outside the plan. This makes it a best-of-both-worlds option for many patients: lower costs in the network, but flexibility to leave the network if necessary.

If you go to a doctor within the PPO network, you will probably pay a co-pay (a set amount for certain services -- like $15 for a doctor visit or $10 for a prescription). Your coinsurance will be based on lower charges for PPO members.

If you choose to go outside the network, you will have to meet the deductible and pay coinsurance based on higher charges. You might also have to pay the difference between what the provider charges and what the plan will pay.

While on the NYU payroll, selecting United Healthcare PPO will give you option to go to almost any NYU physician.

Health Maintenance Organizations (HMOs)
HMOs are the oldest form of managed care plan. HMOs offer members an array of health benefits -- usually including preventive care -- for a set monthly premium. The catch? You must use the health care providers and facilities within the HMO network in order to receive coverage, unless it's an emergency. Most HMOs require a small co-pay for each visit to a doctor or plan facility. Some require no payment when you visit doctors. HMOs generally provide preventive care like annual check-ups, flu shots, hearing tests, etc., at lower out-of-pocket costs to you. This makes them highly preferred for many people who don't want to pay huge fees for an annual physical, a cholesterol check, or other necessary tests. HMOs will give you a list of doctors from which to choose a primary care doctor. This doctor coordinates your care, which means
that generally you must contact him or her to be referred to a specialist.

With some HMOs, you will pay nothing when you visit doctors. With other HMOs there may be a co-payment, like $5 or $10, for various services.

If you belong to an HMO, the plan only covers the cost of charges for doctors in that HMO. If you go outside the HMO, you will pay the bill. This is not the case with point-of-service plans.

Point of Service Plans (POS)
A hybrid of the HMO and PPO is known as a POS plan. Like a standard HMO, your primary care doctors make referrals to other providers within the plan. If you want to go to a physician outside the network without consulting your primary care doctor, the POS plan will only pay a predetermined amount of the bill. You pay the remaining balance which will likely be higher than if you stay in-network. These plans usually cost more in monthly premiums than straight HMOs, but they give you the flexibility to see any doctor – within the plan or not.

Guidelines in every plan
Whether you choose a Fee-for-Service plan, a PPO or an HMO, you will find that your plan has certain rules you have to follow.

Pre-authorization
Almost all insurance plans have some form of pre-authorization. Let's say you fall and break your leg while rock-climbing on vacation, and you are rushed to a hospital that is not part of your HMO network. Your emergency medical coverage is most likely included in your plan. After you've been patched up, however, the medical team feels you would be best served by tricky follow-up knee surgery. Chances are, either you or your doctor will have to call your insurance provider to get the go-ahead for the non-emergency treatment. This is known as "pre-authorization." It occurs when your insurer must approve a procedure before you actually have it. It is generally a good idea to call your insurance company before any major planned procedure (surgery, MRI, voluntary admissions) in order to check on the pre-authorization limits. If you have a procedure done without the required pre-authorization, the insurance company may deny coverage!

Utilization review
Utilization review is a fancy term for the process used by plans to determine whether a specific medical or surgical service is appropriate or medically warranted. The insurance company’s Medical Review Specialist may be brought in to make the final decision about whether or not your insurance will cover the cost of the operation. If they deny you coverage, you generally have the right to appeal the decision.

So what, exactly, are "deductibles"?
A deductible refers to the amount of covered expenses you must pay each year before the insurer starts to reimburse you. Let's say you have a $300 deductible. The first time you visit a doctor, you are required to pay the cost of the examination: $110. Several months later, your doctor recommends that you have your cholesterol and triglycerides checked. You go to the lab, have the blood drawn and pay the lab fees: $80. You return for the results of your tests and your doctor tells you you're healthy as an ox. Then he sends you away with a pat on the back and a bill for another $110. At this point, you have met your deductible of $300. After that, your insurer will reimburse you for each doctor visit or hospital stay - usually 80%, as mentioned above.

Deductibles vary. A typical deductible is $250 per person, but it can be lower or much higher. Some folks opt for a deductible as high as $10,000 (that's right, $10,000) to reduce premiums or to be used in conjunction with a medical savings account. The maximum family deductible is usually three times the individual deductible. As a rule, the higher the deductible, the lower the per paycheck contributions.

Wait a minute ... what are "contributions"?
Contributions are the bi-weekly per paycheck contributions that you make toward the cost of health insurance. They don't count toward deductibles.

Much of this information was condensed from the websites below. Please visit them for more in-depth information about choosing a health insurance plan:
www.healthinsurance.com
http://www.ahrq.gov/consumer/hlthpln1.html

What are my health insurance options while I am a resident?
Please refer to the chart for a quick comparison of the most popular health insurance options while on each payroll. For the most up-to-date benefits information, or if you have specific questions, please contact:

NYUMC Benefits Services:
One Park Avenue (between 32nd & 33rd Sts), 16th Fl.
Phone: (212) 404-3787
Website: http://www.med.nyu.edu/hr/benefits
Fax: (212) 404-3900
Email: NYUbenefits@nyumc.org

OnsiteHR office: (across from NYU Medical Center),
Greenberg Hall, SC-2
Hours: Wednesdays, 8am – 4pm (Closed for lunch 11am – 12 noon)

Bellevue Human Resources:
1st Floor, C&D Building

212-562-3565
http://www.cirseiu.org/benefits/nygovernment/index.cfm

Questions to ask yourself when choosing benefits:

• Do I want limits on my choice of doctors or hospitals? If no, avoid an HMO type of insurance. Consider a PPO or POS instead. Most residents on NYU payroll are happy with the choices provided by United Basic.
• How convenient does my care need to be? If you hate the hassle of switching insurance companies and want to stick with the same insurance company while on both payrolls, consider the Aetna HMO.
• How important is the monthly cost of service versus the quality of coverage? While on Bellevue, GHI insurance is the least expensive. However, many residents have been unhappy with the quality of coverage that GHI provides. Consider springing for one of the slightly more expensive plans if you are picky about which MD’s you like to see.
• How do I feel about keeping receipts and filing claims?PPO and POS plans may require you to file your own claims for out-of-network benefits.
• Who is in my family?Tisch doesn’t cover opposite gender domestic partners. If you have one who needs your insurance coverage, try to get on the Bellevue payroll.
• Do I or my family members have a chronic health condition?If so, speak with a benefits officer and the insurance company at length to determine what services are covered. Luckily, many of the insurance companies have special programs for people with common chronic illnesses to help them manage services. Check these out before you sign up.
• Will it annoy me to have to go to my PMD to get a referral to a specialist, even though I know which specialist I need to go to?Many residents find HMO’s annoying for this reason.
• Will I or a family member be traveling extensively or spending a significant amount of time away from home? If so, consider some of the larger insurance plans as they have more extensive networks in other parts of the country.

Tips from a resident perspective:

• Most residents seem to prefer the flexibility of a PPO.
• Do not automatically choose GHI at Bellevue because it is the cheapest. Many residents feel that this HMO is very restrictive.
• You can waive your healthcare coverage while on both payrolls if you are covered on another policy. If you have a significant other with good health insurance, consider this option. It will prevent you from the hassle of switching insurance every year, and it will save you a hefty chunk of change. (See waiver dollars in the table above.)
• Let your MD’s know that you are an NYU resident. Many will waive the co-pay as a courtesy for all of the hard work you do!
• Some MD’s don’t advertise that they will make exceptions for residents. If you have a particular NYU MD that you are interested in seeing, contact them and ask if they will accept you as a patient even though you may be covered by an insurance company that they normally don’t accept.
• Keep ALL of your paperwork.
• Consider COBRA. According to federal law, your employer must provide you the opportunity to continue with your group health insurance plan for up to 18 months if you desire to do so, if you pay 102% of the full premium yourself. While this can be expensive (up to $350 per month) and a bit complicated, it may be useful. Talk to HR with questions.
• Before you have any major medical work done (MRI’s, surgery, admissions, etc) call the insurance company to see if you need to follow any specific step. This could save you a big headache later on.

Tips on dealing with switching benefit lines:

• When you switch payrolls, please contact the benefits offices (listed above) to insure that your coverage will be started promptly and to check that they do not need additional paperwork from you. Default assignment is not guaranteed--you must actively ensure that your coverage is in place.
• Always make sure both benefits office have your correct contact information, as they will send you mailings to update you on benefit changes even if you are not on their payroll.
• Keep your insurance cards until you graduate from residency, just in case there is a lag in getting your new cards when you switch payrolls.
• Call the insurance company you think you are insured with to check to make sure your benefits are active.
• You can switch your benefits once a year.
• To find an NYU physician that accepts your insurance, click on the website: http://findadoc.med.nyu.edu/

To minimize the hassle of picking a new MD every time you switch insurance coverage, consider picking one of the NYU primary care MD’s that accepts health insurance from both GHI and United Healthcare (see link to table).