In the previous post of this series, we discussed how to use your health insurance to stay healthy. Today’s article will help you understand your coverage.

When you signed up for health insurance, you probably received a Summary of Benefits and Coverage. If you didn’t receive one be sure to ask for a copy! (If you’re a BCBSKS member, log in to BlueAccess to view that information.) This document will help you understand your health insurance plan. It will include what types of services are covered, how much you’ll be paying each month for your plan and other key features. Keep it handy, because it’s a great resource to find quick answers.

You also should have received an identification card. In fact, it’s probably sitting in your wallet right now! Like the Summary of Benefits and Coverage, this card outlines all of your health insurance information in one place, as well as serves as proof of insurance. Be sure to show it to health care providers whenever you receive services. Not all ID cards will look the same, but the information they contain will be similar. Usually you’ll be able to find the following information, among other items:

  • Your name
  • A member number (What your insurance company uses to identify you)
  • A group number (How your insurance company tracks the benefits of your specific plan)
  • The copayment amount (How much you’ll need to pay for doctor’s office or emergency room visits)
  • The deductible amount (The total amount you pay for health care services before your health insurance begins to pay)

Below are definitions of more words that will be commonly used in your health insurance plan.

Network –These are the facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services. In order to minimize your costs, you’ll want to make sure you’re seeking services from providers within your insurance plan’s network.

Premium – This is the amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly. In return for paying the premium, you get protection from the potentially high cost of medical care.

Explanation of Benefits (EOB) – This is a summary sent to you that shows how much your health insurer or plan paid, what your financial responsibility may be, and any provider write-offs. This is typically sent to you each time you receive services.

Next in series: What to do in a health emergency

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