Healthy choice

Open season for the Federal Employees Health Benefits program is upon us

again. Here are some tips that may help you choose wisely for next year.

There is no one best plan. People have different health care needs and

look for different things. Statistically, the most popular plans are the

Blue Cross/Blue Shield standard option followed by the Mail Handlers Benefit

Plan and Government Employees Hospital Association Inc. plan.

To decide which one is best for you, review your recent health care

needs and consider the kind of care you may need in the next year. If you

or a family member has been using a lot of hospital in- patient care and

expect that will continue, seek a plan that has excellent inpatient coverage.

If you need better coverage for doctor's visits, diagnostic tests or prescription

drugs, you might want to consider a health maintenance organization or a

plan that has good preferred provider agreements with a wide variety of

doctors and laboratories.

Regardless of which plan you choose, it cannot impose a waiting period

or any exclusions or limits on benefits because of a pre-existing health

condition. The good news is that all the plans cover hospital and physician

care, prescription drugs, outpatient diagnostic lab tests, treatment of

mental illness, home health care, routine mammograms for women over 35,

routine prostate cancer tests for men over 40 and smoking cessation programs.

Some even cover special benefits such as acupuncture and chiropractic care.

The catastrophic protection benefit is probably the most important add-on

option to consider. This benefit places a dollar limit on the amount of

money you have to pay out of your own pocket for expenses that your plan


HMOs are also worth a look. They cover hospital and physician care,

prescription drugs and stress prevention. Many also offer more comprehensive

coverage, including dental care, at lower premiums than fee-for- service

plans. The downside to HMOs is that you give up control over your medical

care. The HMO decides how much, what kind and the location of your medical

care. And many plans only allow you to use the doctors and hospitals that

are members of the HMO or with which the plan has an agreement. HMOs also

have limited benefits for emergency care.

If you have a chronic health problem, mail-order prescription services

can save you money. If you regularly use many drugs, review the benefits

provided by different plans. In my opinion, the plan that offers the best

mail-order prescription coverage is Blue Cross/Blue Shield.

Remember: The worst mistake you can make is to enroll in a plan that

costs more money than you need to spend. That's hardly a catastrophe, and

you will have an opportunity next year to make an adjustment.

Zall is a retired federal employee who since 1987 has written the Bureaucratus

column for Federal Computer Week. He can be reached at [email protected]


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