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HEALTH INSURANCE:UNDERSTANDING YOUR COVERAGE

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Put Your Health First.

+Health First, How To

There is no substitute for getting and staying healthy.

To put health first: Make time for exercise, relaxation and regular checkups

with your provider. Take an active role in your health. Learn about ways to stay

healthy and share that information with family and friends.

Regular check-ups with your provider is a key part of staying healthy and meeting your health goals.

Keep all of your health information, including providers, medications, and insurance information, in one place.

+ Understand Your Insurance Plan.

+Health Plan Basics

Each health insurance plan works differently. Check with the insurance company to know what services the plan covers and what the services will cost.

Read your health insurance membership package to learn how to locate a provider or call your insurance company to ask a question.

Most plans send members an insurance card as proof of insurance. This card contains important information about the plan, such as: Deductible Copayment Coinsurance Out-of-Pocket Maximum

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Your Insurance Card.Your insurance card contains important information about your health plan features. It’s important to understand this information and keep your card in a safe location.

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Find A Provider.

+Find A Provider That Is Right For You

A provider is medical professional. It can be a doctor, nurse practitioner, or another medical professional.

Each insurance company has a contract with certain providers to provide health care to members. These providers are said to be in-network.

Choosing a provider is a very important health care decision. It takes time and homework. Not every provider fits our needs, so take time to select a

provider.

+4 Easy Steps To Choose A Provider

1. Find the names of some providers near you who are in your insurance plan’s network. Contact your insurance company, look on the website, or

look in the insurance member handbook to find out which in-network providers are near you.

2. Ask Around Do you homework about providers. Ask friends and family

what they like and dislike about their providers. Search the internet to find reviews on providers.

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+4 Easy Steps (Cont.)

3. Narrow down your choices. Once you’ve found potential providers, call their office and ask these questions: Is the office accepting new patients? Is the office close to your home or work? When is the office open? Does the provider respect and value your cultural and

religious beliefs? What hospital does the provider use?

4. Give them a try! You can use the same four steps to find a specialist or your

provider can suggest a specialist. Sometimes it takes more than one visit to figure out if a

provider or a specialist is right for you.

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Make An Appointment.

+Make An Appointment

When you call to make an appointment with the provide, they might ask some questions, such as: Name, DOB, address, Social Security number, and

information about your insurance. Have your insurance member card handy.

Which provider, office location, and appointment time you prefer.

Why you are coming to see the provider and any symptoms you have.

You might want to ask some questions too, such as: Are there forms they can send you before the visit. Is there anything else you need to bring to the visit. Is there a cancellation policy in the event you need to

cancel or change your appointment.

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If you have an

emergency, call

911

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Be Prepared For The First Visit.

+What To Bring To Your Visit

Here are some items you may need to bring on your initial visit to the provider’s office: Insurance card or other documentation Photo ID Any papers or forms that the provider sent ahead for you to fill

out Health history information about yourself and your family A list of prescription medications you are taking, including

dosage and frequency. Bring prescription refills that you need. A list of non-prescription medications that you take frequently Let your provider know if you have allergies to any medications Your copayment, if any Questions or concerns about your health and someone to assist

you to your appointment, if necessary

+Checking-In At Your Appointment For your first appointment with a provider, it is important to

show up minutes early.

When you get to your provider’s office, check in with the front staff. There is usually a sign-in sheet.

The front office staff may ask you to: Show them your insurance card and proof of identification. They

will make a copy for their records so they can bill your insurance company.

Fill out some forms about your health. If you filled them out at home, give them to the office staff.

Read over their privacy policy or show you how they will keep our information private. They may require you to sign that you approve.

If you have a copayment, they may ask you for the payment at the beginning of your visit.

+Talking To Your Provider

Your provider’s job is to help you stay healthy. They can provide better care if you talk with them about health concerns you have.

Asking questions like these may help you: How’s my health? What can I do to stay health? Do I need a test or a health screen? What is the test for? What

will the results tell me? When and how will I get the results? What is my diagnosis? What does it mean for my health? What are my treatment options? What are the benefits and

drawbacks of each option? Are there alternatives? What is the medication for? How do I take it? Are there any side

effects? Are there any interactions with food or other medications?

Remember: Don’t be shy! Speak up!

+Before Leaving Your Appointment Before leaving your appointment, you should be able to

answer the following questions: How is your health? If you have a health condition, what is

it? What will happen if you don’t take care of it? Do you know what to do to get healthier? What tips did the

provider give you to stay healthy? What should you do at home, at work, or in your community to get healthier?

If you need medication, how much do you have to take and when?

What are you supposed to do next, e.g. blood work? When and where do you get it done? When do you see the provider again?

What should you do if you have questions later?

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Decide If You Like The Provider

+Decide About Your Provider

Your health is a personal matter and you should have a provider that you feel comfortable with. Remember: It’s okay if you want to look for another provider.

After your first visit, consider these questions: Did your provider answer your questions? Did your provider and you communicate effectively? Were you

able to understand each other? Did he/she listen to your concerns? Were your health needs addressed? Were you comfortable is the office interacting with providers

nurses and other staff? Is this a place where you would feel good about going back?

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+Decide About Your Provider (Cont.) If you answered “NO” to any of the questions on the

previous page, consider the following: What didn’t you like about the provider? Thinking about these

will help you find a provider that fits your needs. Here are some reasons you might decide to not visit a provider: S/he didn’t understand your health needs S/he didn’t answer your questions S/he didn’t speak to you in a way that was easy to understand S/he didn’t understand you or your family’s background, culture or

religious beliefs S/he didn’t speak your language or use a translator The provider’s office was not in a convenient location

Then, where else might you go? Can you try another provider in the same office? Do you need to start your search over?

If you answered “YES” to each of the questions on the previous page, then congratulations you have a provider that’s right for you.

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Next Steps After Your Appointment

+After Your Appointment, Now What? After your initial visit to your provider, what next?

It’s important to follow your what your provider recommended for you to stay healthy. For example, fill your prescription or see a specialist for further examination.

Follow-up up with your provider if s/he recommended a follow-up appointment or phone call.

Contact your provider if any questions arise regarding your health or treatment regimen.

And remember: One visit is not enough! Seeing your provider regularly is an important part of being healthy.

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QUESTIONS?THANK YOU!

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