An HMO is a type of health coverage that offers health care services through a network of health care providers. A network is a set group of doctors, hospitals, clinics, labs, and pharmacies. You get care and choose a primary care physician from your network. Your PCP will arrange your care and refer you to specialists in the network as needed. It is common for the medical provider to send any bills through your insurance plan directly. If you see two numbers, the first is your cost when you see an in-network provider, and the second—usually higher—is your cost when you see an out-of-network provider.
For example, when you're referred to a specific specialist or sent to a specific hospital, they may not be in your insurer's network. Each person covered by a health insurance plan has a unique ID number that allows healthcare providers and their staff to verify coverage and arrange payment for services. It's also the number health insurers use to look up specific members and answer questions about claims and benefits. If you're the policyholder, the last two digits in your number might be 00, while others on the policy might have numbers ending in 01, 02, etc. Finally, you might see a dollar amount, such as $10 or $25. This is usually the amount of your co-payment, or "co-pay." A co-pay is a set amount you pay for a certain type of care or medicine.
Some health insurance plans do not have co-pays, but many do. If you see several dollar amounts, they might be for different types of care, such as office visits, specialty care, urgent care, and emergency room care. If you see 2 different amounts, you might have different co-pays for doctors in your insurance company's network and outside the network. ISP insurance plans are designed to provide our members with a simple, straightforward claims process.
We hope you'll remain healthy and safe during your time abroad, but if you do need medical care, it should be as easy as possible for you! All of our plans provide access to a network of doctors and medical providers to provide you with convenient access to healthcare. In most cases if you visit an in-network provider within your plan, the provider will submit your claim directly to your insurance plan. Most health plans are required to cover preventive care without any cost-sharing.
This means even if you haven't met your annual deductible, you can still receive preventive care services for free. Preventive care benefits include immunizations, some cancer screenings, cholesterol screening, and counseling to improve your diet or stop smoking. You may be required to receive the preventive care from a doctor in your plan's network.
You can find a list of all the free preventive care services here. Some plans that existed prior to 2010 that have not substantially changed -- known as grandfathered plans -- do not have to provide free preventive services. Check with your insurance company or HR department to find out if your plan is grandfathered. If you do not see your coverage amounts and co-pays on your health insurance card, call your insurance company . Ask what your coverage amounts and co-pays are, and find out if you have different amounts and co-pays for different doctors and other health care providers. May colleges and universities offer some type of health services center to their students and scholars right on campus.
It is always recommended that you first seek treatment at your college or university's student health center when practical. They can often provide many services free of charge or at low cost, and have practical knowledge of the local medical community. If you need additional care, they can usually point you in the right direction! Visiting your student health center will also reduce your out-of-pocket expenses under your insurance plan versus visiting an outside medical provider. For this reason, Summit Health recommends that you learn the specifics of your plan before upcoming health care visits.
Everybody with health insurance should have a doctor who will oversee their medical care. That means you will need to find a doctor -- also called your primary care physician -- who is taking on new patients. If you have young children, you will need to find a pediatrician or family practice physician for their care. Call doctors on the list your insurance company gives you to confirm they are still in the plan's network. Once you've found a doctor who will take you as a patient, set an appointment for your first checkup. In some cases, your health insurance company can give you a list of comparable, in-network health care providers and services.
Health care providers in your network receive full payment from your insurance company for the agreed-upon rate for your health care services. The rate your providers receive includes your insurer's share of the cost as well as your share of the cost. Most patients pay their share of health care costs in a copayment, deductible, or coinsurance. Some health insurance plans require that you get a referral from your family doctor to see a specialist. If that's the case, your doctor will give you a referral to the specialist you need. The specialist may need the referral paperwork prior to seeing you in the office, so make sure all the paperwork is completed.
Check to see if the specialist is in your insurance company's network. If they aren't, you might have to pay a bigger part of the bill or perhaps the whole bill. You can ask your family doctor to refer you to another specialist in your plan's network. When you get out-of-network health care and services, you are likely to be responsible for paying some, much, or all of the cost of the service. The amount you must pay for out-of-network services depends on whether your health insurance company is willing to pay part of the bill. For this reason and to avoid unwanted billing surprises, it is best to check with your health insurance company before you get any out-of-network health care services.
Do All Insurance Cards Have A Group Number Your insurance plan may require multiple copays, higher deductibles, and coinsurance. Coverage will depend on the type of plan you have chosen. You can learn the details of your policy by visiting your insurance company's web site or contacting its customer/member services department. The back of your insurance card should include the phone numbers and Web site addresses you'll need. The Affordable Care Act requires that all health plans sold to individuals or through small employers cover prescription medications.
Although not required, prescription drug coverage is almost universal among large employers.Check with your insurance company to see if they require you to use a pharmacy in their network. Pick a pharmacy close to where you live, and let your doctor or hospital know its name and phone number. Your medical team usually will call the pharmacy directly about the prescription you need.
Otherwise, your doctor might give you a written prescription to take to the pharmacy. For non-emergencies, some HMO plans allow you to get health care services from a Blue Cross and Blue Shield-affiliated doctor or hospital when you are traveling outside of Illinois. If you aren't sure, contact customer service at the number listed on your member ID card before you go. And always remember to carry your current BCBSIL member ID card. It contains helpful information for accessing health care at home or away.
A member ID number and group number allow healthcare providers to verify your coverage and file insurance claims for health care services. It also helps UnitedHealthcare advocates answer questions about benefits and claims. There are, however, private physicians that may require payment at the time of treatment. If you pay for medical services yourself, you can submit a claim for reimbursement. In general, you will need a receipt showing how much you paid along with an itemized bill and completed claim form.
An itemized bill is just a more detailed bill from the medical provider which includes codes and pricing for each service you received. The medical provider can provide this to you upon your request. Any reimbursement will be sent to you via check, less any applicable patient responsibility such as your deductible, copay, or coinsurance.
Each insurance company has different rules for using health care benefits. In general, you will give your insurance information to your doctor or hospital when you go for care. The doctor or hospital will bill your insurance company for the services you get. If you are already seeing a specialist for your condition, make sure your doctor is in your plan's network. If the doctor is not in your plan's network, you will pay more in most cases. Also make sure your specialist uses providers and facilities in your plan's network when sending you for other services or hospitalization.
If you have any questions, call us at the customer service number listed on your member ID card. If you are looking for a doctor for your chronic condition, you can use theProvider Finder tool. Click on "Network Type" at the top and select the name of your HMO plan to see a list of doctors and hospitals in your plan's network. Your member ID number and group number allow healthcare providers to verify your coverage and file claims for health care services. These numbers also help UnitedHealthcare advocates answer questions about your benefits and claims. Your insurance company may provide out-of-area coverage through a different health care provider network.
If so, the name of that network will likely be on your insurance card. This is the network you'll want to seek out if you need access to healthcare while you're away on vacation, or out of town on a business trip. You might see another list with 2 different percent amounts. Your PCP is listed on your member ID card and on your online account. Call to make an appointment with your PCP as soon as you can. Getting a checkup now will help your PCP learn about your health history before any health issues occur.
A doctor or practitioner, specialist, hospital, pharmacy, or other health care provider or service that has no agreement with your insurance company is considered out of network. The "coverage amount" tells you how much of your treatment costs the insurance company will pay. This information might be on the front of your insurance card. It is usually listed by percent, such as 10 percent, 25 percent, or 50 percent. For example, if you see 4 different percent amounts, they could be for office visits, specialty care, urgent care, and emergency room care. Each ISP plan has a designated primary medical network which is easily identified on your insurance ID card.
All of our plans utilize broad national PPO networks, such as First Health, UnitedHealthcare, Aetna Passport, and more. You can also visit our What To Do if You Need Healthcare page to learn more. Reference the section "To find an in-network medical provider in your area" where you can find links to search for participating medical providers in the network applicable to your plan.
It can help cover services ranging from routine doctor visits to major medical costs from a serious illness or injury. It also covers many preventive services to keep you healthy. You pay a monthly bill called a premium to buy your health insurance and you may have to pay a portion of the cost of your care each time you receive medical services.
Globally mobile employees should contact their Regional Service Center using the contact information on their ID card if they need help or have questions. Each RSC is staffed by local experts well-versed in the nuances of that region's healthcare system, ready to guide globally mobile employees through it all. By delivering services locally, through in-market resources steeped in the regional culture and healthcare system, we can anticipate their needs to better support them.
An EPO is a type of health coverage that also has a network of health care providers. Like an HMO, you must use health care providers within your network. But you do not need to select a PCP or get a referral to see a specialist. A PPO is also a type of health coverage with a set network of health care providers. You can see providers outside of the network, but you may pay more. You can also go to a specialist without getting a referral.
Your first premium payment activates your coverage, so you can start using your health plan within 1–2 days of making your payment, depending on how you pay. In this case, the coverage gap would be the time between your requested effective date and the date you make your first payment. Prior authorization means getting approval before you can get access to medication or services. With prior authorization, your health plan agrees to help pay for the service (this is subject to any cost-sharing or other limitations) — and it's important to know that ahead of time.
Review our list ofcommon termsto get more help with understanding health insurance terms. If your member ID card states "Referrals Required," you'll need an electronic referral from your primary care provider before seeking services from another network provider. A referral is when a PCP authorizes a covered person to see a specialist for diagnosis or treatment of a medical condition. Most often, that means you have to contact your PCP before seeing a specialist. The back of your member ID card includes contact information for providers and pharmacists to submit claims.
It also includes the member website and health plan phone number, where you can check benefits, view claims, find a doctor, ask questions and more. Your health insurance company might pay for some or all the cost of prescription medicines. If so, you might see an Rx symbol on your health insurance card. But not all cards have this symbol, even if your health insurance pays for prescriptions. Sometimes, the Rx symbol has dollar or percent amounts next to it, showing what you or your insurance company will pay for prescriptions.
Your health insurance company works with providers to agree upon a rate for a variety of health care costs. Once providers have agreements with your health insurance company, they are considered in network. Doctors and hospitals often contract with insurance companies to become part of the company's "network." The contracts spell out what they will be paid for the care they provide. If you go to a doctor in your insurance company's network, you will pay less out of your own pocket than if you go to a doctor who doesn't have a contract with your insurer. Some insurance plans will not pay anything if you do not use a network provider .
So it is important to consult the plan's network before seeking care. Some health insurance plans include special savings accounts for health-related expenses. The key to getting the most out of your savings account is knowing which type you have and how to use it. Check the information your employer gave you to see whether you have a health savings account , health reimbursement account or flexible spending account .
Then, use the links below to learn more and find important forms and resources. Create a HealthPartners account to get the most from your health insurance plan. You only need to know your member ID number and your birth date. Once you create an account, you can view your benefits, track your medical spending, compare the cost of medical procedures and find ways to lower the cost of care. When you join an HMO, you select or are assigned a primary care physician to coordinate all your health care services. The descriptions below apply to most private health insurance ID cards in the United States.
If you live outside the U.S. or have government-provided insurance, you may see some different fields on your card. The back or bottom of your health insurance card usually has contact information for the insurance company, such as a phone number, address, and website. This information is important when you need to check your benefits or get other information. For example, you might need to call to check your benefits for a certain treatment, send a letter to your insurance company, or find information on the website. If you have health insurance through work, your insurance card probably has a group plan number. The insurance company uses this number to identify your employer's health insurance policy.
