Decision Guide

Choosing a Medical Plan Choosing a Dental Plan Determining Your Insurance Needs

Choosing a Medical Plan

When you select a medical option, you might want to consider the following:

How frequently do you and/or your family members need medical care or see a specialist? When you do get care, do you use in-network providers?
Do you or a family member have a chronic medical condition (asthma, diabetes, arthritis, high blood pressure, etc.)?
Do you prefer to pay more each pay period or pay more if you receive services?
What is your total cost? Be sure to take bi-weekly premiums, any deductibles, coinsurance, copayments and the annual out-of-pocket maximum into account.
Does the option include benefits for out-of-network care? Verify whether your current doctors participate in each plan’s network (either the Montefiore Tier 1 Network or Anthem Network.)

Choosing a Dental Plan

When choosing a Dental option, think about the following:

How do you and your family members generally use dental services – for routine exams only, or do you require more frequent visits and complex procedures?
Does your dentist participate in one of the provider networks? If not, are you willing to choose a new dentist who does participate in the network?
Do you have access to other dental coverage (through your spouse’s employer-sponsored plan, for example)? If so, consider whether it would be more practical for you to cover your family members (or yourself) under that plan instead of a Montefiore-sponsored dental plan.
If you are considering the Cigna DHMO option, make sure that in-network dentists are available in your area and that the dentist you choose is accepting new patients. You might want to go to www.cigna.com, to find an in-network dentist before you choose this option. When you choose the DHMO, you will need to contact Cigna and designate a primary care dentist from the Cigna Dental Care Access Network. If you elect this option, you cannot change to another plan mid-year unless you have a qualified “change in status.”
Consider dental needs, network availability and your total out-of-pocket cost, including your bi-weekly contributions (if any) as well as any deductible, copayments or coinsurance, to determine which plan makes the most sense for you.

Determining Your Insurance Needs

What’s the “right” amount of insurance for you? Here are some tips that can help you decide.

Family status – Your insurance needs will vary widely based on your family situation. Are you single or married? Do you have children? If so, how old are they? Use your answers to these questions to estimate income needs for your family members if something were to happen to you.
Income replacement – How much income would your dependents need to maintain your current standard of living? Be sure to subtract any other sources of income you may have, such as Social Security, income from investments, savings, etc.
Extra expenses – There are other expenses that you may want to factor into your dependents’ future needs, such as funeral expenses, mortgage, health insurance, college tuition, day care, etc.

Keep in mind that the amount of insurance you need today may be very different from the amount you should have 5, 10 or 20 years down the road. It’s a good idea to reevaluate every few years to be sure you and your family have adequate protection in the event they need it.

Nurse in uniform with healthcare team in background.