Insurance Plan Document Reading Audit: What to Check Each Year
Review plan documents for costs, networks and rules.
Added October 15, 2026. Written with AI assistance and checked for clarity and placeholders; not reviewed by a lawyer, accountant, clinician or other professional. How these prompts are made
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[VERIFY] is an editorial flag, not a blank to fill. Wherever the prompt shows [VERIFY], check that item against a reliable source before you use it (what [VERIFY] means).
Audit my health plan documents. The summary of benefits or key terms: [PLAN_SUMMARY]. The providers I use: [MY_PROVIDERS]. Costs I paid last year: [LAST_YEAR_COSTS]. Make a table of premium, deductible, out-of-pocket maximum, co-pays, co-insurance, network status of my providers (as I have checked with the plan), referral and authorisation rules, and exclusions. Compare last year's costs with what the plan terms would produce, with the arithmetic. List questions to ask the plan or my employer's benefits team, and a calendar of enrolment and deadline dates. Highlight changes since last year if I provide last year's summary. This is a reading aid for costs and rules, not medical or insurance advice. Mark everything [VERIFY] with the plan documents. Add a worked cost scenario with invented numbers: premium 3,600 a year, deductible 1,000, 20 percent co-insurance, out-of-pocket maximum 5,000; a year with 3,000 of covered costs gives 1,000 + 20 percent of 2,000 = 1,400 plus premium 3,600 = 5,000 total.
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