How can you get the most from your health plan?
You and your health plan share responsibility for your health care. Knowing how your health plan operates can help increase your satisfaction by understanding how to get the care you need when you need it.
To get the most from your health plan you should:
- Read the member handbook or talk to your employer to understand what services the plan will pay for ("covered services") and what it doesn't pay for ("exclusions").
- If your plan has a member newsletter or magazine, read it to stay current about any new policies affecting how your plan works.
- Know how to choose or change your primary care physician.
- Ask questions if you don't understand information the plan or provider sends to you.
- Know what hours your plan's customer service department and physician's office are open.
- Understand how to schedule appointments for routine and urgent care.
- Figure out when you need a referral to see a specialist or obtain services.
- Know how to get referrals for a specialist, if your plan requires them.
- Know what your plan requires you to do if you need to use a hospital emergency room.
- Take good care of your health by getting appointments for check-ups or other preventive care.
- Ask your doctor questions, including the risks and benefits of any treatments that your doctor recommends.