Tier one operates as an HMO and pays all costs less a co-payment. In tier three, patients can chose a doctor outside the network, and the plan pays 60 percent, less deductible. Choosing the Right Health Plan for You Selecting your health insurance and physician begins with establishing priorities. If low cost and minimal paperwork are the most important features, a health maintenance organization may be worth considering. If you are simply changing HMOs, including moving into Health Net from QualMed, be sure your doctor, preferred specialists, and choice of hospital are all accessible with the medical group you select.
Some individuals choose access to their current doctor over the type of health plan.
If you are satisfied with your current doctor, talk with him or her and the office staff to verify which insurance plans and medical groups within the plans they subscribe to. It is important to fully research your choice of primary care physician as you would any major decision or purchase. The best time to choose is when you are well and have time to interview providers. Another way to find a compatible doctor is through recommendations of friends, family, or co-workers. The handout discusses the types of health insurance available to Berkeley employees, priorities to consider when making choices, and provides a variety of questions to ask when looking for a primary care physician.