Selecting A Primary Care Physician (PCP)
by Karen Kehr, MS
Benefits Manager, American General Financial Corporation

An Employee Benefits Annual Enrollment Follow Up

You are sighing relief and the big decision has been made. The dreaded medical plan option, which good or bad, you are stuck with it until next year. Well, you still have some important follow-up items:

Select A Doctor
If you enrolled in a Health Maintenance Organization (HMO) or a Point of Service (POS), you are required to select a primary care physician. You must communicate your selection to your carrier. If you are enrolled in a Preferred Provider Organization (PPO) plan, you are not required to select a primary care physician. However, those enrolled in a PPO would be wise to review the provider directory for doctors to use when in medical need. Non-use of selected providers may result in reduced benefits (PPO, POS) or no benefits (HMO).

Doctor Credentials
The doctors in the networks are required to meet standards (credentials) set by the carrier. These credentials do vary by carrier. You can be assured that all carriers verify medical schooling and licensure. Some carriers require board certification. Board certification is an additional certification in the field in which the doctor practices. The carrier should be able to provide you this information through member services if it is not indicated in the directory or you may want to contact the doctor's office.

Things To Consider
Other facts to consider in selecting a doctor include; doctor office location and hours, hospital affiliation, bedside manner, years of experience, schooling and side specialties. It might be more convenient to access a doctor close to work or day care than home. Perhaps, it is difficult to leave work so weekend or evening hours may be most convenient. Access to a particular hospital may be important. For example, Houstonians with children would most likely want access to Texas Children's Hospital in the medical center. Or maybe the thought of driving and parking in the medical center sends chills down your spine, so access to a hospital close to home is most important.

Changing Doctors
Unlike your medical plan option, you may change your primary care physician. So while the decision is important for access to care, if you have a less than desirable experience, you may change PCPs up to once a month with an HMO and anytime with a POS.

Review Benefit Changes
Benefit plans do change and you need to be educated on the changes to properly access services. Employers provide written communications of plan changes either in a flyer or brochure. In addition, employers provide summary plan descriptions (SPDs). For example, my company changed to a co-payment drug plan in which certain drugstores must be accessed for services. Some employees overlooked this change and continued as if they could use any drugstore. Needless to say, when they submitted their claims and they were denied, these were not happy campers.

Update Your Life Insurance Beneficiary Designations
As a benefits manager, I have experienced some heart breaking situations when beneficiaries have not been updated. If you don't have a copy of your current life insurance beneficiary designations, ask your human resources department for one. Or if your coverage is not with an employer, check with your personal carrier. I have seen ex-spouses as the designee leaving the current spouse with nothing but the funeral bill.

Changes During the Year
Life events during the year such as a birth, marriage or divorce entitles you to make changes to your benefits options as long as you report the life change within 30 days (some employers allow up to 60 days) of the event. If you do not do it in the time frame required then you will have your current benefit selections until next year. The reason for the time requirement is internal revenue code 125, which allows benefits deductions on a pre-tax basis.

Be a smart consumer!
Employers provide some excellent benefits but it is up to you to use them wisely.

View Karen's Bio