Let's face it. Comparing health plan benefits and features is no day at the beach. And this year, with even more options to choose from, your task can be overwhelming.

But, before you toss your benefit brochures and pick a health plan at random, consider this: a health plan is an investment. It gives you prompt, affordable and convenient access to all types of medical care. Or at least, it should.

That's why it pays to take your time and choose a plan carefully. After all, your decision directly affects the way you and your family receive medical care. And your satisfaction remains the bottom line.

Here are some strategies to evaluate benefits, costs and types of insurance:

Your Strategy

The best plan is one that affordably covers all your medical needs - and links you with a conveniently located medical group.

How Much Medical Care Do You Need?

Step One is simple: assess your medical needs. Think back over the last 12 months - how many times did you see the doctor? Were most of your visits with your Primary Care Physician or did you see specialists? Don't forget Urgent Care and Emergency Room visits. If your health plan covers your spouse or children, tally their medical visits, too.

Using this list as a guide, think ahead to what you might need during the next year. Be sure to include annual preventive care services, such as a physical, gynecological exam and mammogram. If you are expecting a baby or planning a pregnancy, factor in prenatal care visits and a hospital delivery. Some health plans cover genetic counseling and infertility services. If you anticipate the need, write it down.

If you have young children, be sure to include well-baby and well-child check-ups, immunizations and school physicals, along with periodic office visits for illness or injuries.

Once you've compiled this master list of medical needs, you can begin to objectively evaluate each health plan.

Focus on Benefit Differences

Step two is to compare benefits. At first glance, every health plan may seem about the same. It's true that all the plans you're choosing from offer good medical coverage from a panel of local physicians and hospitals. In terms of covered benefits, you'll find the biggest differences in the following areas:

• Chiropractic care and complementary medicine: Are chiropractic services covered, and to what extent? Is acupuncture covered?
• Mental health coverage: What coverage is offered for individual or family counseling services? How big is the panel of providers and what type of referral is needed?
• Vision care: Does the plan cover annual eye exams and eyeglasses or contact lenses?
• Fertility services: Are these covered? Where are the services provided?

In addition, check on your prescription costs and drug coverage - how much will each prescription cost you? Also, how responsive is your health plan to its members? If you want wellness classes to help you manage stress, does the plan cover member education classes?

Take, for example, Western Health Advantage. They offer many benefits including:

• Full benefit coverage for all your needs
• Conveniently located doctor panel
• Copay cost per office visit
• Copay cost for emergency care
• Copay cost for prescriptions
• Freedom to choose own doctor
• Freedom to see specialists in many medical groups
• Customer service accessibility
• Health education provided
• Choice of hospitals

Compare these features and benefits to your own health plan or HMO and this will help you gage benefit differences.

Estimate Your Costs

Your final step should be determining a plan's affordability. Here's where your master list of medical needs really comes in handy. Begin by noting your monthly paycheck deduction for each of the plans in which you are interested. Then add in your cost for each anticipated medical service. With managed care plans, your cost is a fixed amount called "copayment." Copayments for routine office visits are low; copayments for after-hours urgent care and emergency medical care are much higher.

If you prefer a health plan that allows you to see physicians outside the designated networks (non-network provider), estimating costs is trickier. Under this system, every time you see a non-network provider, you must pay a percentage of the cost of that medical service. If you want the security of knowing exactly how much a trip to the doctor will cost, choose a plan with a fixed copayment.

Types of Insurance

Health Maintenance Organization (HMO)

An HMO plan generally provides comprehensive coverage by requiring members to receive services from a contracted medical group.

As an HMO member, you must choose a Primary Care Physician (PCP) from one of the primary care specialties, such as Family Practice, Internal Medicine, or Pediatrics. Your PCP will coordinate your healthcare and refer you to specialists if medically necessary.

The HMO will prepay the Participating Medical Group (PMG) for your membership and healthcare each month. You may be responsible for copays, deductibles and non-covered services.

Usually, referrals are made primarily within the medical group. However, a new not-for-profit HMO, Western Health Advantage, allows you to seek any medically necessary specialty care from any specialist who practices within its network of four medical groups: Mercy Medical Group/Mercy, Woodland Healthcare, UC Davis and the North Bay Healthcare System. This feature gives members much more freedom of choice when specialty care is really needed.

Point of Service Plans (POS)

A POS plan allows the member to choose to receive a service from their Participating Medical Group (PMG) or from a non-participating provider, with two different corresponding benefit levels. HMOs offer some POS plans in addition to or in place of their regular HMO plans, with limited or expanded service levels. Or, a Preferred Provider Organization (see below) may offer POS options as an additional benefit. Many versions of this type of benefit exist and some employers offer their employees the option of choosing from several of these plans.

Medicare Risk HMO Plans

Anyone who is eligible for Medicare may enroll in a Medicare HMO plan. These plans may offer the member more services than traditional Medicare, including periodic health evaluations, pharmacy benefits and hearing aids.

Preferred Provider Organization (PPO)

Insurance companies contract with medical groups and hospitals to provide medical services to PPO members for discounted rates. If you choose a PPO, you select a PCP from a preferred provider network in order to receive your benefits at the lowest cost. If you go "out of network," your fees (deductibles and copayments) may be much higher.

Indemnity Plans/"Fee for Service"

These plans allow you to choose your providers from any group or healthcare facility. You are responsible for a percentage of your healthcare costs, which may take the form of deductibles or reimbursements. One disadvantage of this type of traditional insurance is that it doesn't cover many preventive medicines and procedures, such as routine physicals.

Choosing A Medical Group & Physician

Now that you have chosen a health plan, or have decided to continue with the plan you currently have, focus next on the physicians and medical groups serving the plan. If you already have a favorite Primary Care Physician, make sure the health plan you choose includes him or her. If you can't find a plan that includes all of your doctors, decide which doctor is most important to you - or choose a health plan that allows you to see doctors outside the designated network.

Here are some things to consider as you look for a medical group and health care provider:

Provider Panel Differences

If you don't already have a Primary Care Physician or primary care medical group, you'll need to choose one. Look for one that is conveniently located near your home or office. Offices in more than one city are a plus. Be sure to find out where you'll be sent for lab tests, surgeries, specialist visits or hospitalization. Making an extra trip elsewhere may be inconvenient.

Many health plan members prefer having their Primary Care Physician in or near a multi-specialty office location where specialists, laboratories and diagnostic testing are under one roof. Consider the advantages of choosing Mercy Medical Group as your medical group:

• Ten conveniently located offices
• On-site Laboratory services
• Women's healthcare
• Diagnostic Imaging
• Occupational Health
• Urgent Care
• Care management programs for asthma, diabetes, cardiovascular disease and congestive heart failure
• Member Service Representatives to answer your questions, from interpreting health plan information to finding a physician who is right for you and your family
• Specialty Physicians in 28 medical and surgical specialties, including Allergy and Immunology, Behavioral Health, Cardiology, Eye Care, Obstetrics and Gynecology, Pain Medicine, Plastic and Reconstructive Surgery, Podiatry and Sports Medicine.

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