What to Expect, Now that You’re Covered

Now that you have insurance—you should know what to expect next. Here is some key information that will help you learn how your coverage works and how to get the most out of your benefits. Once you enroll in your insurance plan, you will receive:

  • Your insurance card(s).
  • A benefit booklet and other useful details.
  • A notice of when your policy takes effect and when you can start using your benefits.
  • Regular communication from your health plan about benefits, claims filed by providers on your behalf (called an Explanation of Benefits), and other important details to keep you informed.

Your insurance card:

  • Your insurance card is a reference card that lists your member and group identification numbers plan information, copays and important phone numbers.
  • You will present your member ID card any time you visit a doctor or hospital, or have a prescription filled.
  • Your doctor, hospital, and pharmacy use the information on your card to verify your coverage.
  • If you misplace your card or need more copies, you can request them from your insurance company. Some insurers also offer online access to your account, where you can print a temporary copy of your card and request new cards.

Before you go to the doctor:

  • Get familiar with the basics of how your insurance works. Your insurer’s website will likely have a lot of information, as will other online resources.
  • Check if your provider or hospital is in your plan’s network. Visits to a provider who is not in your plan’s network will cost you more. This information will help you to better plan for out-of-pocket expenses.
  • Before you go to your visit, make a list of questions or concerns you would like to discuss with your provider.
  • Be sure to note of all of your medications if you are seeing a new provider or if you have changed medications since your last visit.

After you go to the doctor:

  • As a member, you are responsible for paying your deductibles and copays at the time of service. Your health insurance company will pay the balance of your cost for medical services directly to your provider.
  • If you paid out of pocket for services that are covered, you can also submit a claim to receive reimbursement.
  • You will be billed directly by your provider for services provided outside of your plan coverage.
  • You will receive an Explanation of Benefits each time you see a provider. This is a summary of what services you received, the amount paid by the plan, and your expected out-of-pocket costs such as deductible, copay and coinsurance.

Paying your premium:

  • If you purchased your own coverage, you will have to pay your first premium before you can start using your benefits. You can continue to use your insurance as long as you keep your payments up to date.
  • Depending on your payment structure, you will receive a bill for your premium:
    • monthly
    • every other month
    • quarterly
  • Your insurer will likely offer a number of options to pay, including credit card payments or drafting directly from your checking account.

Keep your costs down:

  • Only go to the emergency room for a real emergency.
  • Urgent care centers, unlike emergency rooms, are able to save you money when you can’t wait to see your doctor when it is not a serious emergency. Urgent care centers are able to treat illnesses such as colds and flu, do x-rays and treat for minor emergencies such as minor burns, sprains and lacerations.
  • If you have an HMO plan, be sure to use your primary care physician (PCP) as your first stop for care. Your PCP will refer you on if you need to see a specialist.
  • Ask for generic drugs when you receive a prescription from your doctor. Generic drugs are pharmaceutically and therapeutically equivalent to brand name drugs, but cost less.
  • Stay in network when you make an appointment to see a provider.
  • Check your Explanation of Benefits to make sure that you were not charged for services not received.
  • Take care of yourself by getting preventive care, exercising and eating right.