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Your First Year on The Plan

 How To Lower Your Out-Of-Pocket Costs 

Suggestions Concerning
Your Out-Of-Pocket Costs
Prepared By
The Employee Benefit Service Center

6     If You Cannot Get In For an Office Visit; Use Urgent Care
Anytime you feel the need for a doctors care, you should call your doctor first. But, if the doctor is not available, an urgent care center is less expensive than an emergency room. These are independent or hospital affiliated clinics that offer care on a walk-in basis, with long daily hours. Be aware of where they are located when you need them.

7     Search For Less Expensive Prescription Drugs To Address Your Prescription Needs
Drugs are grouped by therapeutic classes and those drugs that treat certain conditions are in the same class. Within each class, the cost of the prescription drugs varies widely. The most expensive drugs are not necessarily the most effective drugs.
Consider generics, one time brand drugs outside the seven year protection time-frame, as excellent options for many conditions. Generics average about $10 per monthly supply. If you use brand drugs, look for the less expensive brand drugs within the therapeutic classes. The cost of brand drugs average $60 per month, but can run well over $100 per month for certain drugs.
 

    Use Mail Service For Your Maintenance Prescription Drugs 
If you have a mail service benefit for prescription drugs and you use maintenance drugs on an ongoing basis, you can obtain a 90 day supply of your prescription for a co-payment amount. This is a cost-effective approach to obtain drugs.

9     Reconcile You Benefits 
Track your medical services and the benefit plan actions to reconcile the physician and hospital bills with Plan payments. Match every medical provider bill with every benefit plan payment to determine if any provider bills are appropriate and accurate.

10    Take Care Of Yourself And Have Routine Physicals
The old saying, "An ounce of prevention is worth a pound of cure", is more true today than ever. Studies show that weight control, proper diet, exercise and refrain from smoking all lead to a need for less medical treatment. Today is the first day of the rest of your life, so start today.

11     Use Home Remedies And Over-The Counter Drugs 
There is no treatment to cure the flu and yet millions of dollars are spend each year for physician visits for the flu. Learn home remedies for cold and flu symptoms, it will save you money. Over the counter medications can be effective in relieving symptoms but ask your pharmacist before buying a drug to understand the risks of any drug and any mixture of drugs you may be taking that may lead to dangerous interactions. Store brand over-the-counter drugs can be less expensive than brand name over-the counter drugs. Buy a good first aid manual and keep it in the house for quick reference

12     Use Your Deductible Wisely
Many Plans have a carry-over deductible, anything spent toward the deductible in October, November or December counts toward your deductible starting in January. If you can delay services that will be applied toward your deductible to these three months, it will help ease the deductible impact in the new year. Check to see if your plan has the carryover provision and, if so, plan accordingly.


13     Make Sure Required Pre-Certification Is Completed 
Understand the pre-certification requirements of your Plan and make sure that all services required to be pre-certified are pre-certified. Your physician will probably accomplish this for you, but should be reminded of the requirement. All plans have a hospital pre-certification requirement and many have other requirements.

14     Certificate of Creditable Coverage 
If you are a new employee and had previous coverage, provide a Certificate of Creditable Coverage to your new plan. If the coverage is creditable, it will help reduce the impact of limits on payment for pre-existing conditions.


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Notice: This information is prepared exclusively for the use
of clients of
The Employee Service Center

Longtime member of the Society of Professional Benefit Administrators (SPBA)

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