Health insurance is important… and complicated, but consumers need to understand what they purchased. Don’t wait for a crisis to find out what is and isn’t covered in your health insurance policy. As people take the time to read their policies, the Division of Insurance (DOI) suggests the following 5 areas as key starting points to better understand health insurance.
· 1. Know what the policy covers and does not cover.Are there items or services the insurance will not cover (known as exclusions and limitations)?If consumers have specific health issues which require certain providers, lab work, and particular prescription drugs, they need to understand how, and if, those expenses are covered.
· 2. What is the deductible and what time period does it cover? The deductible refers to the amount of money that the covered person needs to pay before the health insurance pays for services and procedures. Generally, a higher deductible means a lower premium.
· 3. In addition to the premium, what are the other financial responsibilities? Is there a co-payment for a visit to a health provider or for prescription medication? Does the plan use co-insurance? If so, what amount does the consumer pay? What is your out-of-pocket maximum? The health insurance policy should state the consumer’s financial responsibilities.
· 4. Does the insurance plan offer coverage for out-of-network doctors? While many plans offer coverage when out-of-network doctors and providers are used, some do not, except for emergency care. Out-of-network coverage often requires different co-pays, co-insurance and deductible amounts.
· 5. Understand how the health insurance policy may be renewed or cancelled by the consumer or the insurance company. Consumers need to know what they need to do each year to renew the policy, or if it renews automatically.
The DOI is an information resource for consumers. People with questions or who feel they have been treated unfairly can call DOI or visit our website.