Health insurance gives you better access to medical services, can improve your health, and protects you from paying high out-of-pocket costs when you get sick. This section is meant to help you understand how to use your health plan by explaining your plan’s rules for accessing care and your rights and responsibilities as an enrollee.
Health Insurance Basics
The first thing you need to know are some key terms related to health insurance. Examples of key terms include: Explanation of Benefits (EOB); in-network provider; out-of-pocket cost; formulary, etc. These and other terms are defined to help you understand your health plan’s rules. For more information on key terms and their definitions, click here.
Secondly, it is important that you know what type of managed care plan you have because this will help you get access to the care you need. For example, it tells you if you can see doctors that are outside of your health plan’s network or if you need a referral to see a specialist. If you don’t know what type of managed care plan you have, look on your insurance card, contact your health plan, or contact your employer (if your plan is employer-based). For more information on the different types of managed care plans, click here.
You should also know that you have rights as an enrollee. If your plan refuses to cover a service, you have the right to appeal the service denial, but you have a limited amount of time to do so. For more information on how to fight an insurance denial, click here.
If you have already been through the appeals process and you need help with a medical bill, you have options for how to handle the bill. For more information on how to dispute a medical bill, click here.
Under the No Surprises Act, there is certain information that providers and your plan must give to you. For more information, please use these resources:
- Information providers must give you under the No Surprises Act: Download the PDF
- Information your plan must give you under the No Surprises Act: Download the PDF
If you need assistance understanding your health plan’s rules or accessing care, please contact CHA at 888-614-5400.