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How to Use Your Health Insurance 101
- 3. I have Insurance……. Now What? Using Your Insurance
- 4. Why have health insurance? • Ensure financial security • Obtain preventive services for FREE and stay healthy • Annual physical, check-ups • screenings • prevention counseling • contraception. • A medical home • Manage health conditions, chronic diseases
- 5. Understanding Your Health Coverage • Network • In-Network • Out-of-Network • Deductible • Copay • Coinsurance • Premium • Out-of-Pocket Maximum • Worst-case scenario • Chronic diseases (diabetes, cancer, etc.) • Provider
- 6. Co-Pay and Co-Insurance $ Consumer Patient
- 8. Explanation of Benefits (EOB) • This is NOT A BILL • After you doctor visit, you may receive an EOB from your insurer • An EOB is an overview of the total charges for your visit and how much you and your health plan will have to pay. • If you need help understanding your EOB, you can call ENROLL- Virginia! at 1-888- OR visit our website at www.enroll-Virginia.com
- 9. Where to Go for Care? • Dial 911 if you have an life-threatening situation • Primary Care Doctor • Specialist
- 10. Preparing for Your Visit • Make sure to schedule an appointment in advance • Arrive early to fill out registration forms • Bring your insurance card and ID • Pay your copay
- 11. At your Doctor Visit • Be honest with your doctor about: • Your lifestyle, family & medical history • Medications (request a refill if needed) • Ask Questions! • What is my main problem? • What do I need to do? • Why is it important for me to do this? • How do I see a specialist? • Not satisfied? Change your provider!
- 12. Next Steps After your Appointment • Schedule a follow-up appointment if needed • Fill prescription if needed • Call your doctor’s office: • If you experience any side effects or other problems with your medicines • If your symptoms get worse • To get results of any tests you’ve had • To explain your test results
- 13. Do You Need Help Paying For… • Prescriptions • Needymeds.org • Copays
Editor's Notes
- Facilitator Notes: SPEAK: -Co-payment/Co-pay is a fee you pay each time you see a doctor, get other services, or fill a prescription. CLICK THE DOWN ARROW several times to go over co-pays and co-insurance -Coinsurance is the percentage a covered person must pay (for example, 20 percent) of the allowed amount for covered health services after the health plan begins to pay, usually once the plan deductible has been met. This may also refer to the percentage of covered expenses paid by a health benefit plan. Please take into consideration: You don’t usually have to pay both a copay and coinsurance on the same healthcare service. For example, it would be unusual to pay a $40 copay for a doctor’s office visit, and then also have to pay a coinsurance of 20% of the cost on that same visit. NEXT SLIDE