A Hemophilia Health insurance coverage guide

Sometime ago Andy put together this great list of things you should know about your insurance coverage that is primarily targeted at people who have hemophilia and are struggling with their hemophilia health insurance issues. We hope this will help those of you seeking guidance on this subject.

Things you should know about your insurance coverage 

1.      What are my benefits and do I have a choice of providers?

          a.  Do I have a HMO, PPO?

          b.  Do I have a PBM or designated pharmacy? 

 2.     What is my in network benefit compared to my out of network benefits?

 3.     Where is my factor paid?

           a.  Major medical

           b.   Pharmacy through a PBM?

 4.     What is my lifetime insurance cap?

          a.    If I have a PBM/pharmacy benefit, does it count towards the lifetime cap

          b.    Does it cross over to my major medical?

          c.     Difference in co-pays if I use my PBM compared to major medical.

 5.     Do I have the option of cobra if I leave or am laid off? 

          a.    If so, am I prepared to pay for it?

          b.    Have I contacted PSI for assistance or other organizations that could help?

 6.     Do I have a plan B if I lose my job or insurance?

          a.    Does my state have a high risk pool?

          b.    What are the benefits?

          c.     Can I get private insurance on my own? (not usually)

 7.     If I do change plans, how does this change my benefits and does it give me more or less choices on:

          a.    Factor Providers

          b.    In Network doctors and hospital. (i.e. your HTC)

 8.     Who do I contact at my employer in case I have questions or have a problem?

 9.     What are the best companies to work for and do I know where to find them? Fortunes top 100 best companies to work for (just do a Google search for that)

 10.  Lastly, what other assistance is available?

          a.    State programs like Medicaid

          b.    Federal programs like Medicare?

          c.     Could I qualify?

          d.    What manufacture programs am I eligible for if I lose my insurance?

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