Getting the Most out of Your Health Insurance

We live in an uncertain world where an accident could happen anytime.  Additionally, we breathe in the air that is polluted, drink water that might not be clean and are constantly exposed to other health hazards.  Disease and illnesses can easily be contracted, at times when we least expect it.  That is why it is always good to get health insurance.

Health insurance may be anything that helps pay for any medical-related expenses.  It could be individually purchased, group insurance or availed through a social welfare program and paid for by the government.  Health insurance is often used interchangeably with health benefits and health benefits.

In 2007, the U.S. census estimated that around 85% of American has some form of health coverage, a majority of which get it from an employer and less than 10% purchase it directly.  However, no matter who pays for it, you deserve to know about your health insurance can adequately cover the costs you incurred in any medical situation.

To get the most out of your health coverage, you should:

1. Choose well.

There are many types of health insurance that are available for you.  If you are employed, you may be able to choose which plans to get.  You can discuss your options with your HR personnel, the plan administrator or perhaps your union.  Even if you are purchasing the coverage on your own, you should get as much information about the details of your plan to see if it matches your needs.

2. Know what services are covered in your plan.

Different policies often list different sets of covered services.  It is important that you know what services are covered and what are not because you would have to pay for any medical procedure or medical care that is not listed.

3. Do not ignore the Summary Plan Description.

The Summary Plan Description contains a lot of information about your health benefits and your rights.  It also tells you about the Employee Retirement Income Security Act, a law that governs health benefits for employees.    What is more, it holds information on co-pay services, dependent coverage, as well as plan termination conditions.

Keep a copy of the Summary Plan Description along with any communication about your health plan.

4. Upgrade your plan as necessary.

If you have more children, get married or adopt a child, you would need to revise your health benefits.  You might need to upgrade to adequately cover yourself and your dependents.  The same is true when there is a death in the family, or you get divorced, in which case, you would need to downgrade.

Other life events like resigning or transferring to another company may affect your health benefits.  When you get a new job, or lose your current one, you have the option to buy extended coverage for yourself and your dependents if you are qualified.

5. Coordinate health plans to get maximum coverage.

Spouses who are employed at different companies may have to discuss what plans each would avail of to make sure that they get maximum coverage.

6. Know the laws regarding health benefits.

There are several laws that govern health coverage, and it would make good sense for you to be familiar with them, so that you know your legal rights when necessary.  Some federal laws include the ERISA and the Health Insurance Portability and Accountability Act of HIPAA.

7. Participate in a Wellness Program if Available.

While not expressed mandated by law, the HIPAA enjoins companies to establish and sponsor a wellness program that aims to get employees to start working out, quitting smoking or other general health programs.  You’re not only enjoying a healthier life, but you might gain cost savings.

8. File an Appeal if claims against your benefits are denied.

You should know how to file grievances and appeals with your insurance company, should a health benefit claim gets denied, for some reason.

9. Retirement coverage.

Get to know what coverage and services would be available to you and your spouse in the event that you retire.  This would help you ascertain if you would need Medicare or Medicap.

10. Demand for quality healthcare.

The beauty of the Web is that you now have Health 2.0 Web sites that feature patient ratings and other clinical performance benchmarks.  This will help you find out if an accredited healthcare provider is up to par with set standards.