How Your Health Care Plan Works

How Your Health Care Plan Works

Making Health Insurance Work for You!

Planning ahead can help you save money when it comes to your health. Take full advantage of your health care plan with these helpful tips:

  • Stay in the network. Most health plans, like HMOs and PPOs, use certain groups of doctors, hospitals and other health care professionals called provider networks. If you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost.
  • Stay in the pharmacy network. Just as important as making sure that your doctor is in your network before making an appointment, you’ll save money if you visit an in-network pharmacy.
  • Know what’s covered. Make sure services or treatments are covered before you schedule them. If you have a PPO, you may need pre-authorization (pre-notification) from your carrier before you get certain tests or services. You or your doctor must call the pre-authorization (or pre-certification) number on the back of your member ID card to confirm. Carriers regularly evaluate the use of new and existing medical technologies. This allows them to make decisions about what’s covered. It also ensures that you have access to safe and effective care.
  • Understand health insurance costs. Health insurance costs can be confusing. Knowing what premiums, deductibles, co payments and out-of-pocket maximums are and how they all work together can help you understand your plan.

Where Your Health Plan Works

You can help control your health care costs while at home or during travels. Here are ways to keep costs down whenever you need care:

  • Build a relationship with your primary care provider (PCP). Your PCP will help you stay up-to-date with annual exams and will know who you are if you call with non-emergency questions. Also, your PCP can refer you to a specialist. Remember, it’s easier to get an appointment if you’re already a patient with your PCP.
  • Use the ER for emergencies only. When your injury or illness is serious, call 911 or go to the nearest emergency room. You don’t need a referral. If it’s not an emergency you may be able to save money by seeing your regular doctor for colds, minor sprains and other less serious conditions.
  • You’re covered away from home. Always carry your member ID card with you at all times, especially when you’re traveling. If you have a life-threatening injury or illness when you’re traveling, go to the nearest hospital. Please note that if the hospital is out of network, your costs may be higher. If you have questions before getting care, call your carriers 1-800 number.

Find A Network Provider

Use the online provider directory or call the Customer Service number on the back of your member ID card. If you need emergency care, call 911or seek help from any doctor or hospital right away.