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Look at network, costs when choosing plans

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by Ann Bucy

SBJ Contributing Writer

With so many health insurance options to choose from, how do you know which one is right for you? Should you go with a health maintenance organization or preferred provider organization, which offer lower costs but are more restrictive, or with a traditional plan that may cost more, but allows you to go to the physician or specialist of your choice?

Cathy Powell, individual health care specialist, has worked at Ollis & Company for the last four years. In her work, she sells all kinds of policies to people looking for individual health insurance.

"The first thing you need to do is see if your company is tied in with a network like a PPO or an HMO, or a traditional plan," she said. "With an HMO or PPO, you're limited as to what doctors you can go to, and with a traditional plan you can choose anywhere," Powell said.

"Then you need to find out if your office has an office copay," she said. "This means that you pay part of the bill, and the insurance company pays the rest of it. Some plans also provide for preventive care, like physicals and mammograms. You should find out if your plan provides for that or not."

She added that it is also important to find out ahead of time if the plan includes a prescription drug card. "Prescriptions can cost a lot of money. The typical plan says you pay $10 for the prescription, and the insurance company picks up the rest of it."

Julie Sharp works as a customer service agent in the group health care department at Ollis and Company.

"I believe an employer should have benefits for his employees," she said.

"Everyone needs some kind of in-

surance because you just never know.

If it's a mom-and-pop kind of business, then an individual policy is the way to go then."

When she gets cold calls, she asks the caller their date of birth, sex and what kind of coverage they have now. If they don't currently have insurance, she then asks which hospital they use to determine which plan to go with.

She's written group plans with as few as three employees, as long as they're not related, and as many as 250. Most of the groups the company works with are in Springfield, but there are some in Joplin, also.

Vicki Sanderson is a customer sales and service representative for Nixon & Lindstrom. She's worked there for seven years and has 13 years of experience in the insurance industry.

Sanderson said her company looks at the applicant's sex, age group, whether they have pre-existing medical conditions, the Zip code and county he or she lives in, and whether the individual is a smoker or nonsmoker.

"Every insurance company has pre-qualifying questions," she said. "But they change constantly because of new laws, changing rates and company plans."

Nixon & Lindstrom writes plans from several insurance companies in commercial and personal lines.

Anyone the company can't assist is referred to other companies.

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