After selecting your healthcare plan for the year at open enrollment, your insurance company should send you a packet of educational materials that summarize your plan coverage and plan specifics. This information is important for you, as a healthcare consumer, to digest and keep in a safe place for future reference. If you do not understand these documents, call your insurance provider with your questions. If your company has secured for you a free healthcare advocacy line, such as through your benefits broker, this is also a great option to get your questions answered.
Your health insurance ID card, which will look similar to the image below, is an important piece of this packet from your provider. Your Health Insurance ID Card is proof of your insurance. If you did not receive this card, call your provider to request a one.\
The No Surprises Act
In December of 2020, the United States Congress passed the “No Surprises Act.” The No Surprises Act was put in place to help healthcare consumers better predict their medical costs before receiving care.
Effective January 1, 2022, the No Surprises Act imposed a new transparency rule for group health plans, such as yours, requiring that all ID cards (pictured below) must include plan deductibles, out-of-pocket maximums, how to find a participating provider, and a customer service phone number (which most already have).
Every Health Insurance ID Card now has 10 crucial pieces of information that you should be aware of.
1. Plan type. You may see an acronym like HMO, PPO, HSA, Open, or another word to describe the type of plan you have. Your plan type indicates the type of network your plan has, which dictates the health care providers who are in-network for you.
2. Effective Date: The date in which your health insurance takes effect.
3. Prescription copayment. These are the amounts that you will pay for each prescription you have filled. Name brand medications are almost always more expensive than their generic equivalent.
4. Member name and date of birth. These are usually printed on the front of your card.
5. Member number. This number identifies you and tells your provider how to bill your health plan. If your spouse or children are also on your coverage, your member numbers may look very similar.
6. Group number. This number is also used to identify you and tell your provider how to bill you, as well as tracks the specific benefits of your plan.
7. In-Network & Out-of-Network Deductibles: These amounts reflect the health costs you are responsible for before the health plan starts sharing costs in both in-network and out-of-network situations.
8. In-Network & Out-of-Network Out of Pocket (OOP) Maximums: The out-of-pocket max is the most you will pay in a given year for all covered services. This is a combined total of deductible, coinsurance and copayments made for any one individual. Once the out-of-pocket max has been met, all covered services are covered with no additional cost share.
9. Copayment. These are the amounts that you may owe when you get health care.
10. Phone numbers. Questions about finding a provider, what your coverage includes, how much you will pay for a service or how to navigate billing and payments? A member services number will be listed on your card, in the front of the back, for you to call for help.
Additional Health Insurance Terminology
Participating Provider: A care provider (Doctor, Geriatrician, Internist, Nurse Practitioner, Physician Assistant, Gynecologist, or Pediatrician) who is a part of your health insurance plan’s network of providers and have a negotiated discount on select services, which will save you money!
Healthcare Advocate: A Healthcare Expert who (in compliance with HIPPA) assist you in navigating your healthcare needs whether it be problems with a claim, billing discrepancies, understanding your explanation of benefits, or any other questions you have regarding your healthcare.
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Preparing For Your Well Visit
Your annual well visit (also referred to as an annual physical, checkup, or exam) is covered at 100% by your health insurance provider. Seeing your doctor each year is a crucial piece of an effective preventive care routine.