Seven Ways to Get the Most Out of Your Insurance Benefits

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  1. Ask basic questions about your healthcare coverage before you need to use it. Review the plan booklet you received from your employer, paying particular attention to the Schedule of Benefits and Exclusion sections. Result: You’ll have a better understanding of which benefits you’re entitled to.
  2. Understand the type of plan you have. Is it an indemnity plan? A PPO plan? Is it paired with an HSA or an HRA? Result: The type of plan you have will determine how your insurance benefits work. If you understand your plan benefits, you’ll be able to better control your out-of-pocket costs.

    For example, an indemnity plan offers one level of coverage for any provider you visit (e.g., 80 percent). A PPO plan, on the other hand, uses a network of providers who have agreed to provide you services at a discounted rate. If you visit a physician outside this network, you have to pay a higher percentage for those services (e.g., services from a PPO network provider may have a $500 deductible with 90 percent coverage, while services from a non-PPO network provider may have a $1,000 deductible with only 70 percent coverage).
  3. If you have a PPO plan, verify your physician is in your network before your first visit. Many networks have a website that lists the providers within the network. Additionally, you can call your PPO network using the phone number on the back of your medical ID card. Result: Selecting a physician within your network will enable you to get the most out of your plan, while paying the least.
  4. If your physician refers you to another provider, verify he or she is also part of your PPO network. Result: This will ensure you receive the appropriate discounted rates and are able to take full advantage of the benefits you are entitled to.
  5. Look at your certificate to get a broad overview of your plan. A customer service representative will be more than happy to answer any questions you may have about expenses you may incur, your deductibles, general benefits and services that may need to be precertified. Result: The more comfortable you are with your plan, the easier it will be to navigate the healthcare and insurance systems.
  6. Ask your group’s Plan Administrator if you have questions about an explanation of benefits you receive. Result: Better understanding of your EOB will help you make the proper healthcare choices moving forward.
  7. Access any covered family member’s medical claim and eligibility information through our website at www.starmarkinc.com. Result: This tool will enable you to keep track of your family’s medical claims and expenses throughout the year.

Copyright ©2008 Star Marketing and Administration, Inc. Information in this newsletter may not be reproduced in whole or in part without permission from Starmark. The articles contained within this newsletter are not a promise of coverage and are not meant to replace professional medical advice or service. Personal health issues should be discussed with your physician. Refer to your Certificate of Insurance or Policy for benefit information.