There is something deeply annoying when people in a particular trade or industry start using jargon and letters to talk to us. What is wrong with the English language? Why must they hide the meaning? Why do they believe we will be impressed? The insurance industry is one of the worst offenders. By the time the experts have finished describing the different health plans and the lawyers have wrapped everything in obscurity, we seem left with a take-it-or-leave it choice. They seem to be saying, “close your eyes, trust everyone has your interests to heart, and pick something out of the alphabet soup.” Well here is a quick tour through two of the most common plans to help you decide.

The essence of all plans is a definition of the healthcare professionals available to deliver the care should you need it. The wider the choice you have, the higher the premiums you will be required to pay. With a Health Maintenance Organization (HMO), a group of healthcare providers contracts with an insurance company to deliver services to the policy holders. Because the insurance company guarantees a high volume of business to the group, the rate for the services is lower than usual and so the premium rates charged and copayments are also lower. Access to the services is controlled by a primary care physician. He or she will refer you on to other members of the group for different specialist services. If you want to go outside the group, you will have to pay the difference between the HMO rate and the actual cost of your own choice doctor. Although this is the cheapest form of plan, the lowness of the fees charged by the group encourages members to see as many patients as possible every day.

A Preferred Provider Organization (PPO) also contracts with an insurance company, but the relationship is less restrictive and the rates are slightly higher. In this plan, you are free to choose any doctor within the group without having to get a referral. If you decide to see someone outside the group, you will have to pay the out-of-pocket expenses. Here, you are paying slightly more to have more control over your treatment options. So, for example, if your own doctor is not a member of an HMO, you would have to change. With a PPO, you can continue to see your own doctor.

All health insurance decisions are a balancing of costs and benefits. In this case, the choice between an HMO and PPO comes down to what you can afford and whether you prefer more control over the care you and your family receive. It is fair to say that the majority pick the cheaper option of an HMO and then complain about the restrictions. This does not mean the quality of the care is worse than in a PPO. It simply reflects most people’s preference to make their own informed decisions. Perhaps it is cynical but, whichever you pick, it is better than not having insurance. When the choice is offered through your employer, look carefully at the cost differences in copayments and out-of-pocket expenses. If you are paying privately, get the maximum number of health insurance quotes. When you see a wide range of offers, it is easier to find the best deal.

Washington likes acronyms when it comes to lawmaking and this new law is no exception. This is the Genetic Information Nondiscrimination Act (GINA) and this November sees it finally come into force. Because it affects both employers and the insurance industry, this has been a hard-fought change and was only signed into law last year. Now it should prevent you from obvious discrimination. Sadly, it does not rule out discrimination by backdoor means. If an employer overhears you talking at the water cooler or routinely surveys local news including the obituaries, it is legal to use this information. But, overall, you should find some improvement. It covers two different situations with the same type of result. Firstly, it prohibits employers from asking you to go through a genetic test or making genetic information the basis of deciding whether to hire, promote or fire you. Secondly, it prohibits insurers from testing or demanding genetic information about you or your family in deciding whether to offer you coverage, in setting the premium rate and level of the deductible, or continue the cover.

Let’s be completely clear. The law does not care who is asking for the information If it is going to be used for either purpose, the asking is unlawful. If this happens to you in an interview, it may pose a dilemma. If you cite the law and refuse to answer, the interviewer may think you a troublemaker with something to hide and not hire you. That you can complain to the local Department of Labor and take satisfaction in seeing a civil penalty imposed, this does not replace the offer of employment in these difficult economic times. The temptation to answer will be strong. But when it comes to insurance companies, you must stand up and assert your rights. If the insurer persists, report to your state’s Department of Insurance. This will put the insurers at risk of losing their license to sell policies in your state. This is a big stick to wave in defense of your rights. More importantly, the Department can order the insurers to offer you insurance on regular terms which protects you. Once employed, it’s just as important to stay alert. The operators of group health plans are known to offer incentives like lower premiums to employees who answer a questionnaire including questions about their family medical history. Obviously, insurers want to know if there is a risk of serious diseases like cancer. You might be more at risk if there is a history of cancer in your family. Everyone should refuse to answer.

The reason for the law is important. Genetic tests are increasingly important in diagnosis and deciding on the best treatment for medical problems. Too many patients were refusing these tests because they feared discrimination should their employers or health insurance companies learn of the results. The medical profession strongly supported this change in employment and insurance law. Doctors want to be able to make an accurate diagnosis which means using the best available tests. With this law in place, your rights should be protected. If you are considering a change in insurer, remember you cannot be discriminated against when the companies give you health insurance quotes. They must always be able to prove their quotes are close to the average for people of your age, gender and general social background. If you think you are being victimized, complain.