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It’s not uncommon for employees to have questions about their health plan. In fact, a 2015 Harris poll found that two in five insured Americans did not have a good understanding of the services actually covered under their healthcare plans.
To help, we worked with our member support team to assemble the top eight questions employees have about their health plans and answered them in language everyone can understand.
For more helpful employee communication tips, access our 2018 open enrollment guide.
Your employer will provide you with a Summary of Benefits Coverage that summarizes the key features of the plan (or plans) offered. This document details the benefits covered under the plan, including what you can expect to pay for services, coverage limitations and exceptions. If you have questions regarding your Summary of Benefits, your Human Resource department is able to provide you with a copy and review with you.
Healthgram members may access their Summary of Benefits through their Member Portal and ask any questions through the online customer service tool or over the phone.
Related resource: 10 must-know health insurance terms
The best way to understand who is covered under your plan is to review which plan selection you are currently enrolled in. If you have specific questions about coverage of a spouse or dependents, you can review your plan information in your Member Portal, call your Healthgram Advisor or speak with your HR department.
Dependent children are typically allowed under the plan until they turn 26 years old, but plans can vary so check with your HR for more accurate information.
If you would like to make any changes to your plan it needs to be completed during your company’s open enrollment period. These changes may including adding or removing dependents (spouse, children) or changing the plan you are currently enrolled in if your employer offers more than one plan option. Outside of Open Enrollment, however, changes are only allowed when there is a Qualifying Life Event.
According to Healthcare.gov, a Qualifying Life Event includes the loss of existing health coverage including job-based, individual, and student plans, losing eligibility for Medicare, Medicaid, or CHIP, and turning 26 and losing coverage through a parent’s plan. Household changes, such as getting married or divorced, having a baby or adopting a child or experiencing a death in the family, also count as qualifying events. To know exactly which qualifying events are included in your plan, review your plan document or contact HR.
Your insurance company has partnered with specific networks to provide you with doctors, facilities and providers that would be considered in-network. The specific network has negotiated discounts with this group of medical professionals, so charges in-network should always be lower than those out-of-network. Out-of-network providers can end up being significantly more expensive and you may be responsible for the full amount charged for that visit. Healthgram makes it easy to search for in-network providers using your member portal.
Related resource: How human resources teams can help lower out-of-network utilization with effective communication
Understanding your plan is the key to managing your health care expenses. The following four tips can also help you become an informed healthcare consumer and in turn can help you save on healthcare related spend.
For more money-saving tips, start with this blog post.
Always go to the ER for emergency situations, like a suspected heart attack or a broken bone. For non-life threatening health conditions, a trip to urgent care is usually more cost-effective, as there is a significant cost difference between the emergency room and urgent care. If the problem occurs during your primary care doctor’s regular office hours, call first and make sure you’re headed to the right place. Sometimes your regular doctor can squeeze you in on the same day.
Related resource: ER, Urgent Care, or PCP? How to Know Where to Go
Healthgram helps thousands of employees navigate the ins and outs of their health plans with the goal of creating more empowered and engaged consumers. Contact our team to learn how we can help you save on healthcare costs and create an experience employees love.
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The Thrive blog team is made up of health journalists, health coaches, Advisors and other experts who take what we know and turn it into helpful guide for you, our members. Have a question for one of our Health Coaches to tackle? Tweet it to us at @healthgram.
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