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Get to Know Your Health Insurance Plan Better

Getting covered with the right health insurance plan is important for you and your family to stay healthy. But it takes a lot of patience to understand what your plan covers, the benefits and costs associated with it. Our Health Insurance Basics resource center is a good place to start. We have simplified the essentials further in this blog to help you make the most out of your health insurance. This is to make sure- when an emergency hits, you are ready.

Let’s look at a 5 step guide to know your plan inside out

Understand the Summary of Benefits and Coverage (SBC): It is very important to read and understand the SBC thoroughly while enrolling in health or medical insurance plans because this lets you compare the standard information provided by each plan and make an informed choice. This will help you know what is covered by the plan and what costs you incur. Remember to keep a copy of your health insurance plans’ SBC for future reference. On April 6, 2016, the Centers for Medicare and Medicaid Services (CMS) released the final 2017 SBC template. Click here to learn more.

What are the costs associated with your health insurance plan:

  • Premium: the amount that must be paid to a health insurance company for a health plan. Consumers and/or their employers pay this monthly, quarterly or yearly.
  • Copayment (or copay): is a fixed amount consumers pay for a health care service. The amount varies based on the type of service covered. For example: seeing a doctor will have a lower copayment, than an emergency room visit. Also, recall in-network services will have lower copayments than out-of-network.
  • Deductible: the amount a consumer owes for health care services before the health plan begins to pay. Some health services may be covered prior to meeting the deductible. Premiums and copayments do not count towards the deductible. For example: Deductible of the plan is $1000. The consumer must pay $1000 for services before the company pays for any subsequent service.
  • Coinsurance: is the consumer’s share of the cost for a covered health service, calculated as a percentage of the amount allowed by the health plan for that service. The consumer would pay coinsurance plus any deductible owed. For example: The service allowed amount costs $100, the consumer would pay 20% or $20. The health plan would then be responsible for the remaining $80.

health insurance plan

Understanding your health insurance plan inside out is the first step in accessing quality health care.

Find a health care provider: The best way to choose a provider is to see whether they are in-network or not. The term “provider” simply means health care professional. It could be your primary care doctor, nurse, psychiatrist, or any other health professional. Contact your insurance company to find out which providers are “in-network.” “Out-of-network” provider usually costs more. To start with you will first see a Primary Care Provider for most health issues and then a Specialist to treat specific conditions.

Where to go for care: This is perhaps the most confusing question for many when it comes to getting immediate care. There are three options:

  • Your Doctor: Call your doctor’s office first to get a quick opinion about your medical condition, as they know your history to make quick recommendations.
  • Urgent Care: If your condition isn’t life-threatening but needs to be taken care of right away, then you should look at finding the nearest urgent care center. They are usually open after normal business hours, including evenings and weekends. Many offer on-site diagnostic tests like x-rays and lab services. Also, note that you save time and money by going to urgent care instead of an emergency room.
  • Emergency Room: Visit the emergency room for a life-threatening medical condition like uncontrolled bleeding, chest pain, heart attack, difficulty breathing and possible stroke.

Get prepared for your doctor visit: Health insurance covers costs of preventive care that can help you stay healthy. This includes routine doctors’ visits for things like checkups, cholesterol screenings, and immunizations such as the flu shot. When you visit your doctor for the first time, make sure you have your health insurance card and previous medical records to refer when needed.

It is absolutely necessary that you are at the peak of healthy body and mind at all times. Since, modern civilization leaves no space for us to stay away from a host of different decisions, we need to be guarded with as much clinical and financial protection as possible. To make sure you are protected from all sides, understand your health plans well, and go through the guidelines of health step wise.



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