|Summer 2020 Volume 13, Number 2|
What the Coronavirus Taught Us
Wash your hands and check your health care benefits to see what's covered!
Because of the COVID-19 coronavirus pandemic we've learned a new term — social distancing — and relearned the importance of thoroughly washing our hands.
Where to Go to Learn About Your Benefits
One important lesson we can take away from this unprecedented experience is that you shouldn't wait until you're ill or a pandemic strikes to learn what type of health care benefits you have. You also don't have to just rely on calling your health plan's customer service line — which can unfortunately be a long wait during a time of crisis.
Member Welcome Kit
One of your most valuable sources of information is the welcome kit that is mailed to you when you enroll in a plan. Most welcome kits feature:
Your ID card is not only your proof of insurance, it also gives providers information on what you will owe as a copay and where the provider should submit a claim.
Insurance carriers provide login, or self-service sites for members to find out more information about their health benefit plans. Not only do these sites usually contain information about benefits, but they also may feature plan documents, claim payments and coverage dates. Some sites allow members to make changes in coverage and update address changes.
Summary Plan Description
Plan administrators must offer covered members a Summary of Plan Document (SPD) which tells participants:
If a plan is changed, participants must be informed, either through a revised summary plan description, or in a separate document, called a summary of material modifications, which must be provided free of charge.
Explanation of Benefits
After a medical provider submits a claim to your insurance company for services rendered, the insurance company will pay the claim and send you an Explanation of Benefits (EOB). This is a statement about your medical insurance claim. The insurance company usually mails the EOB to you, but it may also post it in the login or self-service website. The EOB looks like a medical bill — but it isn't. It explains what portion of the bill the insurance company paid to the health care provider and what portion of the payment, if any, is your responsibility. You should pay any portion of the medical expense not covered by the insurance company, such as a deductible or a co-pay, directly to the provider.
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