The Department of Labor’s Employee Benefits Security Administration ( EBSA ) relies on the provisions of several important health insurance laws that apply to employers’ health insurance programs. These laws cover the following:
- Your basic right to be informed about how your health plan works,
- How to qualify for payments and apply for them,
- Your right to continue your health plan if you lose coverage or change jobs, and
- Protection against special diseases.
For more information about the laws that protect your payments, visit the Employee Benefits Security Administration website or call EBSA toll-free at 1-866-444-3272.
These 10 tips will help you make sure your health insurance benefits you.
1. Explore health insurance options
There are many different types of health insurance programs. Find out what your employer offers and then check out the program(s). Your employer’s human resources department, health plan administrator, or your union can provide information to help you match your needs and preferences with the programs offered.
Or consider purchasing a health insurance program from the Health Insurance Marketplace. Visit HealthCare.gov to see the health insurance options available in your area. Get information about all the options and study them. The more information you have, the better your health insurance decisions will be.
2. Explore available payouts
Decide on your needs and priorities. Do the insurance programs offered cover benefits that are important to you, such as mental health services, newborn care, vision care, or dental care? Are there franchises? What additional costs may you face? Consider all your options before deciding which insurance coverage to choose. Matching your needs with those of your family members will allow you to get the best coverage possible. The cheapest is not always the best. Your goal is quality and affordable medical care.
3. Read the summary of your health plan ( SPD ) for a lot of useful information.
The SPD sets out your benefits and legal rights under the Employee Retirement Income Security Act (ERISA ), a federal law that protects your medical benefits. It should also tell you about coverage for dependents, what services require co-pays or additional insurance, and when your employer can change or terminate your health plan. In addition to ” SPD “, Summary of Benefits and Coverage ( SBC ) is a concise and easy-to-understand summary of program coverage and costs. Your health plan administrator must provide a copy of both documents along with the enrollment materials. Keep the SPD , SBC, and all other informational brochures and health insurance documents, as well as any notes or correspondence with your employer regarding medical benefits.
4. Use your health insurance
Once your health plan starts, use it to cover medical expenses for services such as doctor visits, prescription drugs, or emergency care. Using health insurance will help you and your family stay healthy and reduce medical costs. Affordable Care Act-ACA) protects beneficiaries of employment-based health insurance programs, including prohibiting exclusions for pre-existing conditions, as well as annual and lifetime restrictions on essential health care services. What’s more, many programs cover certain preventive services free of charge, including routine immunizations, regular visits to your child and childcare, blood pressure, diabetes, and cholesterol testing, and many cancer screenings. In addition, your children may be included in your health insurance program up to the age of 26. Use your health insurance, especially free preventive care is covered by your program. If you are paying a share of the cost of preventive services, review the program’s explanation of benefits to make sure the healthcare provider billed the service correctly.
5. Find out about mental health and substance use disorder coverage under your insurance program
Many health insurance programs provide coverage for mental health and substance use disorders. If the program offers such benefits, the financial requirements (such as co-payments and deductibles) and quantitative treatment limits (such as a limit on the number of doctor’s visits) for these benefits cannot be more stringent than those applicable to medical/surgical benefits. In addition, insurance programs may not impose annual or lifetime limits on the dollar amount of mental health and substance use disorder services, including behavioral disorder treatment. Some insurance programs provide free preventive services, such as depression screening and child behavior assessments. See ” SPD ” and ” SBC ” find out about your plan’s coverage.
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