Benefits

Does the health plan promote and make available to its members health risk assessments, such as patient surveys, and routine health screenings such as those for depression and blood pressure?

Diabetes can increase the risk for such medical conditions as high blood pressure and depression. It is important for people with diabetes to have routine health screenings and to know if their health plans offer such preventive screenings at no charge or a minimal charge. Check to see if the health plan informs members of these benefits. Health plans that promote routine health screenings can help members to identify potential health problems before they become dangerous.

What diabetes-related medications and blood sugar monitoring devices (name brand or generic) does the health plan cover?

Annual out-of-pocket costs for diabetes-related medications and blood sugar monitoring devices can be high, depending on the pharmacy benefit that the health plan offers. When evaluating a health plan's benefits, carefully review the list of medications and supplies (sometimes called a formulary) it covers to be sure the list meets your current and potential needs. Ask the plan how often it reviews, adds, subtracts, or changes this list. Plans with mail order prescription services may save members time and energy.

Are the benefits easy to understand? Which benefits will the plan cover?

Ask the health plan for a booklet that reviews all the services the plan offers its members. People with diabetes should check to see that the plan covers diabetes medications, syringes, blood glucose monitoring monitors and supplies (such as strips), eye and foot exams, required lab tests such as those for A1C or glycosylated hemoglobin (HbA1c) and microalbuminuria (protein in the urine), immunizations (for flu and pneumonia), routine medical exams, and self-management education. If you are unsure about the coverage, ask a customer service representative from your health plan to explain. If the benefit literature is not easy to read and understand, you may have difficulty tracking your current coverage and/or changes in your coverage. Easy-to-read benefit materials can mean that the health plan wants to keep its members informed and to have them actively use its services. In addition, look for member satisfaction surveys and other information from the health plan that indicates its desire for member feedback on its services.