Tip: This is important because knowing the type of plan you are in will give you an idea of how much flexibility and control you have over the providers you can see and the types of services you receive.

Tip: While most HMOs require primary care providers to coordinate patients’ care ("gatekeepers"), some HMOs have open access plans. These plans allow the patient to choose any PCP or specialist in the network without a referral.

Tip: Some health plans allow members to seek care from non-network providers–often at an increased cost (e.g., POS, PPO). HMOs on the other hand, generally require that you obtain your care from a network provider (with limited exceptions). If the plan allows you to seek care from non-network providers, find out if there are any restrictions or additional costs.

Tip: You should ask the health plan for the "clinical protocols" it uses to treat your health condition. Clinical protocols are guidelines a managed care plan uses in deciding whether a person with your condition should receive certain health care services or treatments. These will help you anticipate how a particular condition may be treated by the managed care plan as well as assist you with an appeal and/or grievance. Managed care plans are required upon request to give you a copy of their clinical protocols or utilization review criteria. If you don’t understand what it means, ask a health care professional whom you trust to help you decide if the guidelines are appropriate for your health condition. If not, ask if there is a process to request a different treatment plan if it differs from the standard clinical protocol.

Tip: If you have a hearing impairment, you should find out if the health plan has TTY equipment. If you have a visual impairment, you should find out if the health plan can send you information in braille, large print type or make other arrangements to ensure you receive all information.