Fundamental guide on the operation of health insurance

health insurance

Choosing a health plan can be overwhelming. Between the unfamiliar terms, mysterious acronyms, health savings accounts, and optional coverage, there’s a lot to learn. Wouldn’t it be great if you could find all the information you need about how health insurance works in one place?

Then you are on the right page. Here’s a breakdown of everything you need to know to prepare for open enrollment, the annual period when you choose health coverage for the following year. You don’t need to study everything. Choose what seems most relevant to your life. Soon, you’ll be able to select coverage with confidence.

 #1 What are premiums, deductibles, coinsurance and copayments?

The first thing many people want to know is where their money is going. These insurance terms refer to the different types of payments for which consumers are responsible. The amount you’ll pay varies from plan to plan: For example, higher premiums often mean lower deductibles. Watch the short video to learn what each term means, then read customer scenarios to find out which plan best fits your life.

#2 What is the difference between HMO, POS, PPO and HDHP plans?

Each of these acronyms stands for a type of health care plan that allows you to access doctors and services in different ways. With some plans, referrals are required to see a specialist, while with others, they are not; In some plans, a national network of doctors is offered, while in others, coverage is only local. In the video, you will discover what makes each plan special. Read our customer stories to find out which one suits your needs.

#3 Differences between an FSA and an HSA: How do health care accounts work?

If you like to save money, you’ll want to learn more about flexible savings accounts and health savings accounts. Both allow you to deposit pre-tax dollars to cover health care expenses, so you save about 30 cents on the dollar. Discover the unique advantages of each account in the short video. Customer stories are helpful in deciding which account is right for your health and financial goals. Then, learn about the expenses that qualify to be paid from your health account.

#4 What benefits can I get through my health insurance?

Your health plan may offer benefits you don’t know about…but should know about. Some subsidized gym memberships; others have a medical hotline you can call 24/7. Find out what benefits you have access to so you can get the most out of your health plan.

 #5 Is it worth buying vision insurance?

Prescription glasses and contact lenses are not covered under most medical plans. To do this, you must complement the plan with vision insurance. Even if you have very good vision, an annual eye exam can detect early signs of general health problems.

#6 Does my situation require special insurance coverage?

Vision insurance isn’t the only add-on you can add to your medical plan. During open enrollment, you may be offered optional or “voluntary” plans to cover dental expenses, hospitalizations, disability, and more. Watch the video to discover more about your options, then read the article to see how other people selected additional coverage based on their health and budget.

#7 What health care decisions do I have to make when I get pregnant?

If you plan to get pregnant next year, you should check that potential plans have maternity and newborn coverage. Is your hospital or birth center in the network? Does your insurance company offer breastfeeding education and support? Learn more about what to look for in a health plan when you’re considering getting pregnant.

#8 Where can I get health advice and other special support?

Does your health insurance provider support you outside of the doctor’s office? When selecting a plan, ask about programs to help you meet your health goals. For example, some plans will connect you with personal coaches with experience in smoking cessation, weight loss, infertility, sleep problems, stress reduction, or managing a condition.

#9 What digital health tools do I have at my disposal?

Nothing replaces human support, but sometimes the right digital tool is all you need. Some plans give you access to a suite of health tools that let you access health information anytime, anywhere. Teladoc, for example, allows users to video chat with doctors from a computer or smartphone to get a preliminary diagnosis. Cost estimation tools are used to anticipate fees for a variety of tests and procedures. These are just two ways technology improves your health care experience—and your health.

#10 When can I change my health plan outside of the open enrollment period?

Open enrollment is the yearly period when you can make changes to your plan or choose a new one. But some special circumstances, called “qualifying changes in marital or family status,” allow you to make changes outside of that period. Find out what planned or unexpected situations allow you to upgrade the plan.


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