How Can I Get the Most from My Plan Health Insurance? 

How Can I Get the Most from My Plan?

You will get the best care if you:

Stay Informed

  • Read your health insurance policy and member handbook. Make sure you understand them, especially the information on benefits, coverage, and limits. Sales materials or plan summaries cannot give you the full picture.
  • See if your plan has a magazine or newsletter. It can be a good source of information on how the plan works and on important policies that affect your care.
  • Talk to your health benefits officer at work to learn more about your policy.
  • Ask how the plan will notify you of changes in the network of providers or covered services while you are part of the plan.

Take Charge

  • Ask your doctor about regular screenings to check your health. Discuss your risk of getting certain conditions. What lifestyle choices and changes might you need to make to lower your risks or prevent illness?
  • Ask questions and insist on clear answers.
  • Ask about the risks and benefits of tests and treatments. Tell your doctor what you like and dislike about your choices for care.
  • Make sure you understand and can follow the doctor’s instructions. You may want to bring another person along or take notes to help you remember things.

Keep Track

  • Write down your concerns. Start a health log of symptoms to help you better explain any health problems when you meet with your doctor.
  • Set up health files for family members at home. This will help you to monitor care. Include health histories of shots, illnesses, treatments, and hospital visits. Ask for copies of lab results. Keep a list of your medicines, noting side effects and other problems (such as other drugs and foods that should not be taken at the same time).

How Do I Obtain Care?

Learning what you can expect from your health plan and how it works are key steps to getting the care you need. Ask these questions:

  • When are the offices open? What if I need care after hours?
  • How do I make appointments? How quickly can I expect to be seen for illness or for routine care?
  • If I need lab tests, are they done in the doctor’s office or will I be sent to a laboratory?
  • Will most of my appointments be with the primary care doctor? Will nurse practitioners or physician’s assistants sometimes give care as well?
  • Is there an advice hotline? Some plans have toll–free phone services that help members decide how to handle a problem that may not require a doctor’s visit.

Find out how your plan provides care outside the service area and what you must do to get care. This is especially important if you travel often, are away from home for long periods, or have family members away at school.