Check the exact plan, doctor and prescription

• Record the full plan name, plan year, insurer, network name and plan ID from the benefit documents.
• Open the insurer’s current provider directory and formulary for that exact plan. Save the date you checked.
• Confirm the directory applies to the individual plan you are considering, not another product sold by the same insurer.

Checks and notes stay in this page and are not submitted or saved by SJI. Avoid entering account numbers or medical details. Print for your records.

• Look up each doctor at the actual practice location you use. Check the hospital, clinic, lab and imaging facility separately.
• Ask the insurer to confirm participation for the exact plan and location. Record the date, representative and reference number in your own records.
• Ask the doctor’s office to confirm participation and whether it is accepting patients under that plan. Resolve any disagreement with the insurer before enrolling.
• Check referrals, prior authorization and out-of-network rules for planned care. A network listing alone is not approval for a service.
• For an ongoing course of treatment, ask the insurer about transition-of-care procedures and whether any authorization must be requested again.

Checks and notes stay in this page and are not submitted or saved by SJI. Avoid entering account numbers or medical details. Print for your records.

• Check the exact drug name, strength, dosage form and supply quantity against the plan formulary.
• Check the tier and whether a separate deductible, copay or coinsurance applies.
• Look for prior authorization, step therapy, quantity limits and specialty-pharmacy requirements.
• Confirm the pharmacy and any mail-order option are in network for this plan.
• If a drug is not listed or a restriction is unclear, ask the insurer about its exception process and coordinate with the prescribing clinician. Do not change medication based on this checklist.

Checks and notes stay in this page and are not submitted or saved by SJI. Avoid entering account numbers or medical details. Print for your records.