If you’re looking for a new health insurance plan and unsure about what to ask for, don’t worry — we’ve got your back. In this post, you’ll find a summary of the different components of coverage.
You may find that a plan’s coverage is nearly identical to your last one. If you’ve been with the same insurance company for years, you’re likely getting a similar plan with a few changes here and there. The best way to figure out if you’re getting a new plan is to look at the summary of benefits, also known as the SBC. This is a one-sentence summary of the plan’s benefits, including preexisting health conditions, maternity coverage, and other important information.
Before the SBC is given to you, you may have to fill out an application. The application acts as your contract with the insurance company, so make sure that you understand everything before signing it. Suppose you have any questions or concerns after reviewing the SBC and signing the application. In that case, you may want to speak with your insurance company representative about them.
If you are unsure about any health issues or questions, discuss them with your doctor before signing the application. If your doctor has a different opinion from the one in the application, let them know. Some doctors are very protective of what their patients get from their insurance companies. Still, others will support you if there’s a discrepancy between what is suggested in the application and what your doctor recommends. If this happens, explain why you think the decision is wrong to ensure that it doesn’t affect coverage for any future medical conditions that may arise.
Another thing you should always look out for is if there are any limitations or exclusions to your policy. You may want to visit as many listings as possible and check the fine print. For example, some policies may exclude from coverage any prescription medications that you’ve already received or had prescribed for you under the previous policy. Don’t be afraid to ask about this — it’s not uncommon for a new plan to have exclusionary terms to encourage consumers to switch from the more expensive, standalone prescriptions of the old policy to a more cost-efficient plan with multiple co-pays and deductibles.
When reviewing your new policy, remember that a provider may ask for referrals from your primary care doctor. This is generally not an issue, but if you’ve moved recently, you may find that your old primary care doctor no longer accepts the plan. In this case, it’s a good idea to keep a list of alternate providers who accept the plan and will not raise any red flags with your insurance company.
Always be prepared to ask plenty of questions when looking for a new plan. If you’re not sure what to ask, we’ve made it easy by providing you with a list of important questions that you can always rely on. Before signing the application, make sure you understand each component of your plan: how much coverage do they offer, are there any limits or exclusions, and should I contact my doctor about this? Remember that a representative from the insurance company will have the answers to these questions for you.
Here is a breakdown of some elements from an SBC to understand what it means.
What Is Covered?
If there is anything that you’re wondering whether you’ll be covered for, chances are it’s on here. The most common coverage includes dental care, eye care, mental health services, prescription drug coverage, etc.
What Is Not Covered?
This is one of the most important sections of the SBC. Be sure to read through this section carefully to ensure that you are not paying for any services that will not be covered. Some things you might not be covered for include dental and vision care, weight loss or cosmetic surgery, or even mental illness. If there is anything you think will not be covered, ask about it before signing up for the plan.
How Much Does It Cost?
This section may seem confusing at first, but don’t worry — we’ve got your back. Included in this section is an “out-of-pocket maximum.” This refers to the maximum dollar value of the plan that you will have to pay for covered services.
The out-of-pocket maximum varies from plan to plan, but it’s generally at least $7,000, and it can go up to $15,000. To find out your out-of-pocket maximum, check the plan’s summary of benefits and coverage that you received when you signed up for the plan.
How Often Can I Go to the Doctor?
You can visit a physician or a specialist as often as possible. Ask your insurer how often they have a system in place where you can see a specialist without needing to see your primary care physician first. This is also sometimes called an “urgent care” visit.
What Is My Deductible?
Your deductible is the amount you have to pay out-of-pocket before your insurance company covers the rest. For example: if your plan has a $1,000 deductible and you get an X-ray that costs $100, your insurance company will only cover $900. The remaining $100 is on you. To have this charge covered, you’ll need to reach your deductible limit of $1,000.
How Much Be Will My Co-Pay?
Most plans include co-pays for various services and medications prescribed by a physician. They’re usually listed on your SBC in the “Other Doctor’s Fees” area.
How Much Can I Go Over My Limit?
This section is different for each plan. They may include how much of a particular medication you can take, how much coverage you have for prescriptions, or even how many days you can have a medical emergency. Be sure to read the plan’s Summary of Benefits and Coverage to ensure that these limits are what you expect them to be.
Deposit or Deposit Refund?
This might be confusing at first, but your deposit or deposit refund is any money you pay into your health insurance plan in advance — whether it’s money toward your deductible or the premium itself.
Some plans will refund a portion of your deposit when you cancel the policy. If you plan on canceling your policy, be sure to ask if you will receive a refund.
What is the Renewal Date?
This is particularly important if you have a small business health plan or large group coverage. It’s important to renew these plans with your insurance company before the end of their term — otherwise, you’ll have to go through the whole application process again! Be sure not to miss that deadline!
What is covered if My Spouse or Child is covered?
In some cases, having one family member covered through your health plan might also cover other family members. For example, if one of your adult children is covered through your plan, their spouse and children (if any) are also insured. Ask your insurance company how they define a “family member,” and be careful not to get overcharged for a specific service.
If you’re looking for a new health insurance plan and unsure about what to ask for, don’t worry — we’ve got your back. In this post, you’ll find a summary of the different components of coverage.
You may find that a plan’s coverage is nearly identical to your last one. If you’ve been with the same insurance company for years, you’re likely getting a similar plan with a few changes here and there. The best way to figure out if you’re getting a new plan is to look at the summary of benefits, also known as the SBC. This is a one-sentence summary of the plan’s benefits, including preexisting health conditions, maternity coverage, and other important information.
Before the SBC is given to you, you may have to fill out an application. The application acts as your contract with the insurance company, so make sure that you understand everything before signing it. Suppose you have any questions or concerns after reviewing the SBC and signing the application. In that case, you may want to speak with your insurance company representative about them.
If you are unsure about any health issues or questions, discuss them with your doctor before signing the application. If your doctor has a different opinion from the one in the application, let them know. Some doctors are very protective of what their patients get from their insurance companies. Still, others will support you if there’s a discrepancy between what is suggested in the application and what your doctor recommends. If this happens, explain why you think the decision is wrong to ensure that it doesn’t affect coverage for any future medical conditions that may arise.
Another thing you should always look out for is if there are any limitations or exclusions to your policy. You may want to visit as many listings as possible and check the fine print. For example, some policies may exclude from coverage any prescription medications that you’ve already received or had prescribed for you under the previous policy. Don’t be afraid to ask about this — it’s not uncommon for a new plan to have exclusionary terms to encourage consumers to switch from the more expensive, standalone prescriptions of the old policy to a more cost-efficient plan with multiple co-pays and deductibles.
When reviewing your new policy, remember that a provider may ask for referrals from your primary care doctor. This is generally not an issue, but if you’ve moved recently, you may find that your old primary care doctor no longer accepts the plan. In this case, it’s a good idea to keep a list of alternate providers who accept the plan and will not raise any red flags with your insurance company.
Always be prepared to ask plenty of questions when looking for a new plan. If you’re not sure what to ask, we’ve made it easy by providing you with a list of important questions that you can always rely on. Before signing the application, make sure you understand each component of your plan: how much coverage do they offer, are there any limits or exclusions, and should I contact my doctor about this? Remember that a representative from the insurance company will have the answers to these questions for you.
Here is a breakdown of some elements from an SBC to understand what it means.
What Is Covered?
If there is anything that you’re wondering whether you’ll be covered for, chances are it’s on here. The most common coverage includes dental care, eye care, mental health services, prescription drug coverage, etc.
What Is Not Covered?
This is one of the most important sections of the SBC. Be sure to read through this section carefully to ensure that you are not paying for any services that will not be covered. Some things you might not be covered for include dental and vision care, weight loss or cosmetic surgery, or even mental illness. If there is anything you think will not be covered, ask about it before signing up for the plan.
How Much Does It Cost?
This section may seem confusing at first, but don’t worry — we’ve got your back. Included in this section is an “out-of-pocket maximum.” This refers to the maximum dollar value of the plan that you will have to pay for covered services.
The out-of-pocket maximum varies from plan to plan, but it’s generally at least $7,000, and it can go up to $15,000. To find out your out-of-pocket maximum, check the plan’s summary of benefits and coverage that you received when you signed up for the plan.
How Often Can I Go to the Doctor?
You can visit a physician or a specialist as often as possible. Ask your insurer how often they have a system in place where you can see a specialist without needing to see your primary care physician first. This is also sometimes called an “urgent care” visit.
What Is My Deductible?
Your deductible is the amount you have to pay out-of-pocket before your insurance company covers the rest. For example: if your plan has a $1,000 deductible and you get an X-ray that costs $100, your insurance company will only cover $900. The remaining $100 is on you. To have this charge covered, you’ll need to reach your deductible limit of $1,000.
How Much Be Will My Co-Pay?
Most plans include co-pays for various services and medications prescribed by a physician. They’re usually listed on your SBC in the “Other Doctor’s Fees” area.
How Much Can I Go Over My Limit?
This section is different for each plan. They may include how much of a particular medication you can take, how much coverage you have for prescriptions, or even how many days you can have a medical emergency. Be sure to read the plan’s Summary of Benefits and Coverage to ensure that these limits are what you expect them to be.
Deposit or Deposit Refund?
This might be confusing at first, but your deposit or deposit refund is any money you pay into your health insurance plan in advance — whether it’s money toward your deductible or the premium itself.
Some plans will refund a portion of your deposit when you cancel the policy. If you plan on canceling your policy, be sure to ask if you will receive a refund.
What is the Renewal Date?
This is particularly important if you have a small business health plan or large group coverage. It’s important to renew these plans with your insurance company before the end of their term — otherwise, you’ll have to go through the whole application process again! Be sure not to miss that deadline!
What is covered if My Spouse or Child is covered?
In some cases, having one family member covered through your health plan might also cover other family members. For example, if one of your adult children is covered through your plan, their spouse and children (if any) are also insured. Ask your insurance company how they define a “family member,” and be careful not to get overcharged for a specific service.
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