Know Your Insurance Coverage

Knowing your health insurance and what it covers is an important part of staying healthy and keeping health care costs manageable.

Health insurance plans are all very different – and two people covered by the same company may have different plans with different requirements.

Some important parts of your health insurance to know:

Deductible – The Deductible is the amount that you must pay out of your own pocket before the insurance company will begin paying towards any covered expenses. The deductible affects how much money you will pay to the doctor or hospital, and is typically paid at the time of treatment. Depending on the plan, the deductible may be paid once per calendar year or once per new condition.

Co-pay – This is an amount you must pay out of pocket before the insurance company pays for eligible expenses. Typically this is required instead of a deductible or coinsurance and requires you to pay a set fee for a specific service (for example, $25 for an office visit.)

Co-insurance – This a percentage of what your insurance will pay to cover your health care cost after any deductibles or copays have been met.

Provider network – This is a group of providers who have contracted with the insurance company to provide services. In-network providers will typically accept reimbursement from your insurance provider, while out-of-network providers may not. In-network providers may also be available at a lower cost to you.

Preventative care  – Most health plans cover preventative care at 100 percent. Certain screenings and vaccinations fall under the guidelines of preventative care. Some types of screenings can be preventative or diagnostic depending on your personal health history. For example, a colonoscopy can be screening because you have no symptoms, or can be diagnostic because you have symptoms or a diagnosis. Some lab work may also be considered either screening or diagnostic depending on your personal health history. If in doubt, talk to your insurer before you have a screening, so you understand how your preventative care benefits work before the bill arrives.

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