Review Your Health Plan Details

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Learn about your health plan

After you sign up for a health plan, you’ll receive information about your new health plan from the health insurance company.  Be sure to watch out for the following:

  • Your health insurance ID Card. This card is mailed to you and includes information about your health plan.  Carry this card with you when you go to the doctor, hospital or pharmacy.  Note: The card may arrive a few weeks after your coverage kicks in.  If you need care before then, call your insurance company.  Generally, the companies have procedures to print out temporary cards in such cases, or they will make some other arrangement with you.
  • Your Summary of Benefits and Coverage (SBC). This document gives you an overview of what the plan covers. For example, you’ll find a list of health services and the costs you may pay if you use an in-network provider or an out-of-network provider.  Generally, your insurance company will mail you this information, but you can also find it online.  You can also click here to access SBCs, as well as directories of providers, lists of covered drugs, and other information.
  • Get familiar with the costs you may pay. Here’s a primer on the basics:
    • premium is a monthly fee for health insurance.
    • The deductible is the amount of money you pay before your plan starts to help you pay your bills.
    • copay is a payment you make at the doctor’s office, urgent care clinic, ER or the pharmacy. Example: A $20 copay for doctor visit.
    • Coinsurance is a percentage of costs you pay for your health services. Example: A bill for 20 percent of the cost of surgery.
    • The maximum annual out-of-pocket limit is a limit on the amount you have to pay annual for covered health services. Once you reach this limit, the plan will pay 100 percent of the cost of covered services.
  • Learn about in-network vs. out-of-network care. If your health insurance plan has a network of providers, you’ll pay lower costs when you get your care from a provider in the network. Learn more about choosing a provider in the network.