Don't be overwhelmed by the volume of reading materials about your health insurance plan.
Reading your health insurance plan will help you understand your coverage. There are some key areas to pay special attention to. The information you receive will be from your human resources department or the health plan directly. The information will be in the form of benefit summaries, a document called summary plan description, or online at the member portal of your health plan's website. Your employer may distribute detailed information about your health benefit options during open enrollment. Some companies choose to place this information on their intranet or website.
Instructions
1. Find the glossary of common health-insurance terms to learn the jargon used in your health insurance plan. The glossary is often found at the end of your benefits information or summary plan description or on your health plan's website.
2. Locate the type of health plan you have. Plan types include health maintenance organizations, preferred provider organizations, point of service, high-deductible health plans and indemnity plans. Match the type of plan to the glossary to understand the plan's basic concept. For example, HMOs require you to visit a primary-care provider before seeing a specialist and limit you to their provider networks.
3. Review the deductible of your health insurance plan. The deductible is a dollar amount you must pay, out-of-pocket, before the health insurance plan begins paying. The plan may only pay a percentage, say 80%, of your medical bill. The other 20%, the co-insurance, is your responsibility. Look for co-insurance percentages in your health plan materials.
4. Note differences between in-network and out-of-network benefits. If you have both, a side-by-side comparison will list the different coverage amounts of in- vs. out-of-network services. You may notice that in-network care coverage is 100% paid by the insurer but out-of-network is a much lower percentage.
5. Look at the co-pays for various health-care services. Health insurance plan information will contain the co-pay amounts for services such as preventive care visits, routine visits, specialist visits, outpatient procedures, hospitalization and mental-health and substance-abuse treatment. Each plan has different co-pays varying from zero to much more.
6. Find the section in your health insurance plan information about pre-authorization of services and excluded services. Pre-authorization is typically required for hospitalization, surgeries, mental-health and substance-abuse treatment and experimental procedures. Additionally, a list of excluded services, such as cosmetic procedures, is located in your summary plan description.
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