Glossary

What You Get With Your Plan

If you have health insurance, you probably already know that you won't have to spend a fortune when you see a doctor. You got the basic idea.

But your health insurance probably covers more than you realize. (And, in some cases, maybe less.) You pay good money for this stuff - make sure you know what you're getting.

Carry your health insurance membership card wherever you go. It can help you find a doctor and cover your medical costs while you're traveling. Whether you're visiting the slot machines in Vegas or one of the wonders of the world, don't leave home without it.

See more info on away from home care.

Medical Coverage

Basic medical insurance typically covers emergency services, routine care like physicals and exams, doctor visits, and lab tests. 

The amount that your plan covers depends on the fine print in your plan. Few plans cover 100 percent of the cost of any medical service, and your copayments and deductibles can add up. Some plans limit the number of visits or tests they'll cover each year. Others may require that you pay all your costs on your own until you reach a limit when the plan kicks in.

On the flip side, health insurance protects you by capping the annual amount you have to pay. So if you get really sick or injured, you can have peace of mind knowing that you’ll never have to pay more than that amount in a given year.

Also, most health plans cover only services that they consider medically necessary. Thinking about Botox or aromatherapy sessions? You’ll probably end up footing the whole bill.

 

Prescription Drug Coverage

Don’t assume that your health insurance covers prescription drugs. Check with your health insurer about your drug coverage and how much drugs cost. This is especially important if you take a lot of medicine for chronic conditions like high blood pressure, high cholesterol, or asthma.  

Formulary

Find out if the prescription medicine you take is listed on the health plan’s drug formulary. A formulary is a list of drugs that your health plan pays for. You may still have to pay a portion of the drug cost through a copayment. The formulary is determined by the health plan based on things like price, effectiveness, and safety. The formulary may categorize the drugs into different tiers, ranked by the cheapest to the most expensive:

Formulary

Get the most bang for your buck. Ask your doctor or pharmacist if generic drugs are available for your prescription. Generic drugs are cheaper, but are just as safe and effective as brand-name drugs. Brand-name drugs usually cost more because those companies have to recover high research, development, and advertising costs. They may also have patent protection that prevents other drug companies from making them. It’s like buying $200 designer jeans versus $50 jeans with a lesser-known label. They have a similar look, fit, and function despite the different price tag.

Mail-order

You should also find out if the health plan offers a mail-order prescription drug program that conveniently mails a three-month supply of maintenance medications to your home. Maintenance medications are long-term medicines for things like birth control and ongoing medical problems like high blood pressure, high cholesterol, arthritis, or diabetes. Ordering medications through the mail saves you money.

Preventive Care

Thanks to the 2010 health care reform law, all health insurers are now required to cover preventive screenings like cholesterol tests, colonoscopies, immunizations, prenatal care, and routine care for children at no extra cost to people they cover. Cheehoo! But, as with all health benefits, make sure you know exactly what’s covered, when it’s covered, and how much of it is covered. We’ll let the people who created this law explain it to you.

You might be thinking – do I really need all those tests and screenings? Why, yes you do! Screening for things like cancer and other chronic diseases can save your life. These diseases are often called “silent killers.” That’s not just to scare you – it’s the truth! Many diseases have no symptoms, so even though you feel fine, something really dangerous could be developing inside you. Disturbing, huh?

Besides eating healthy, exercising, and taking good care of your health, getting screened is the most important thing you can do to stay healthy. And, don’t forget – it doesn’t cost you extra!

Health & Wellness Support

Here’s something I bet you don’t know: you’re supposed to eat healthy, exercise, and not smoke. Kidding. We all know these things, but knowing and doing are very different. Sometimes we need a little help – education, support, or a gentle kick in the okole to reach those health goals.

Here’s something you might not know: your health insurer probably offers classes and programs to help you. Lots of insurers offer things like stop-smoking or weight-loss coaching, educational classes and seminars, discounts on health products and services, behavioral health support, and even rewards for meeting your health goals. Be healthy and save money? That’s a pretty sweet deal.

Away From Home Care

Health care is the last thing you want to worry about when you're traveling. But accidents or emergencies can happen … wherever you are.

Whether you're on vacation in a foreign country or going to school on the Mainland, find out if your health plan pays for care away from home, including in that location.

Get peace of mind so you can enjoy your trip. Do your homework before you get on the plane. Consider these questions on your travel checklist:

  • Where are the nearest doctors or hospitals in the area I'll be traveling to?
  • Where is the nearest emergency room?
  • What kind of care do they provide?
  • How is the quality of care?
  • Will doctors or hospitals accept my health insurance?
  • Will I have to submit claims to my health insurer or will that paperwork be done for me?
  • What is the number to call if I have questions or need help?
  • Does my health insurance help pay for prescription drugs? Where is the nearest pharmacy? 

Take care of your medical needs before going on your trip. Don't wait until the last minute. Get the necessary shots or vaccines. Take enough medicine with you to last your whole trip. If you feel a cold coming on, see your doctor right away. You want to avoid having to see a doctor on your trip.

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