Check the network.
Then check the prescriptions.

A blank review checklist for comparing a proposed medical plan with current coverage. Use placeholders for employee-specific questions. Do not record employee names or diagnoses.

Current plan / exact network:

Proposed plan / exact network:

Effective date / date checked:

Person responsible for follow-up:

1. Confirm the right plan and network

Use the full plan name and exact network/product name, not just the carrier name.
Check the provider at the specific practice address and hospital/facility location.
Check important specialists, hospitals, clinics and behavioral-health access separately.
Check whether new patients, referrals or authorizations affect access.
Record the carrier source, check date and unresolved discrepancy. A directory search is not a coverage guarantee.

Provider / facility review log

Scroll the table horizontally to read each column.

Provider or facility No patient name	Location + exact proposed network	Source / date Who confirmed?	Status + next step
			□ Confirmed □ Needs follow-up □ Not listed
			□ Confirmed □ Needs follow-up □ Not listed
			□ Confirmed □ Needs follow-up □ Not listed

If sources disagree, resolve the question with the carrier and provider before relying on the comparison. Employee-specific questions should use an agreed private channel.

2. Review prescription access and employee cost

Check the exact drug, strength and form against the applicable plan-year drug list.
Record the tier, deductible treatment, copay/coinsurance and any prior authorization, step therapy or quantity limit.
Check required pharmacy, specialty-pharmacy and refill arrangements.
Check both coverage and employee cost; a formulary listing alone does not answer every condition.
Record who will resolve open questions. Do not promise a medication will remain covered indefinitely.

Scroll the table horizontally to read each column.

Medication placeholder Strength / form	Drug-list source Plan year / check date	Conditions + cost-sharing question	Status / next step
			□ Checked □ Needs follow-up
			□ Checked □ Needs follow-up
			□ Checked □ Needs follow-up

Decision record

Questions resolved by / date:

Questions still open / owner:

What changes for employees?

Decision / next review date:

Use the SBC, plan documents, directories and drug list together. Out-of-network or excluded costs may not count toward the stated out-of-pocket limit.

Reading: Benefit Experts network and prescription audit · SBC explanation

Discuss the next step

Discuss medical benefits with Benefit Experts. Bring your business goals and questions to a benefits review. Keep employee medical details out of a general inquiry.

Benefit Experts · 206.556.2993 · benefit-experts.com/contact/