While having health insurance is important for when you are sick and needing treatment, it is also an important player that assists with financing care that maintains your health.
As a benefits plan member, your coverage likely includes many free services such as immunizations for children and adults, annual well visits, obesity screening and counseling for all ages, and more.
Healthcare plans differ in many ways. The most notable difference is in deductible and out-of-pocket maximum amounts. An important part of understanding your healthcare coverage is understanding the terms and acronyms, such as deductible and out-of-pocket maximum, commonly used in healthcare.
Here is a list > of 10 common health insurance terms that you, as a healthcare consumer, should know.
Once you have chosen a plan that best meets yours/your family’s needs, ask your insurance provider for a Summary of Benefits and Coverage document which will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions.
What Will My Care Cost?
Here are some questions you can ask your insurance company to help you better understand your coverage and what you will pay when you get health care.
• How much will I pay for a primary care visit? A specialty care visit? A mental/behavioral health visit?
• Would I have to pay a different amount if I see an “in-network” or “out-of-network” provider?
• How much do I have to pay for my prescription medicine, and is there a generic version available?
• Are there limits on the number of visits I can schedule with a provider, like a behavioral health provider or physical therapist?
• How much will it cost me to go to the Emergency Room if it’s not an emergency?
• What is my deductible?
• Do I need a referral to see a specialist?
• What services are not covered by my plan?
• Does my visit require prior authorization? If so, is there a list of procedures that require the prior authorization?
