3. Notify your health providers.
Let your doctor and pharmacy know that you have new health insurance coverage. They usually ask each time you visit whether anything has changed in this regard, but not always.
4. Summary of Benefits.
The summary of benefits is a great place to review the rules when it comes to deductibles and when they apply. Even if you have the same insurance company and plan from last year your benefits, deductibles, co-insurance, and co-pays can change from year to year.
5. Understand the provider network.
The provider network may be a national network such as those with many PPO plans, or the provider network may only service a certain county within your state. There may, or may not, be services available out of network at a higher cost to the member. No matter the network, life threatening emergencies will be covered whether in or out of network.
6. Make sure preferred hospitals are in-network.
For those receiving care for a major medical condition yet were forced to switch health insurance plans for a number of reasons, may be able to continue receiving care at their preferred hospital for a short period of time until transitioning to an in-network provider.
7. Always use in-network doctors.
If your plan offers coverage for out-of-network care, be aware that such care will likely cost you a bundle in out-of-pocket expenses. You may have a favorite, long-time doctor, but if they are not in-network it is rarely worth the added expense in this broker’s humble opinion. Out-of-network services can be many thousands of dollars of added expense.
8. Rules of your health insurance plan.
Most HMO policies require that you have a primary care physician (PCP.) The PCP is the gatekeeper. To see a specialist you most likely need a referral from your PCP. Some insurance companies assign a PCP to you, while others like Blue Cross and Blue Shield of Arizona allow you to pick your own through their large network. When it comes to prescriptions, no matter the type of plan, you will likely need insurance company approval for pricey medications.
9. Know your pharmacy and benefits.
If your prescription benefits do not cover a certain medication, it is possible to request an exception. This entails your PCP most likely writing a letter requesting that the medication be covered. If coverage for the medication is still denied after requesting an exception the patient may appeal. Whether using a preferred, non-preferred, or mail-order pharmacy, it is always a good idea to shop for the best price as costs can vary widely.
10. Out of pocket maximum.
The goal in life is to never meet your deductible or out-of-pocket maximum. Not reaching these dollar levels mean that you are most likely in good health. The out-of-pocket maximum is self-explanatory. Once met, the patient will no longer be required to pay a deductible, co-pay, or co-insurance for in-network services, and possibly medications.
11. Set up auto-pay for health insurance premiums.
Your health insurance policy will be cancelled for non-payment of premiums. The safest bet to avoid such a scenario is auto-pay. Auto-pay can be set up through the member’s online portal.