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Exploring health insurance:

Tips to make your plan work for you

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Don’t settle for less than the best you can get

You’ll want to keep these tips in mind when you’re picking a plan.

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Explore all of your health insurance coverage options

There are many different types of health insurance plans. The more information you have, the better your decisions will be.

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Consider different types of plans

For example, an HMO often offers lower costs but requires you to stay within a certain network of health care providers for your care.

A PPO provides a larger pool of participating doctors and hospitals and allows you to see non-preferred providers if you choose, although you will have to pay more.

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Learn your plan’s rules about
prior authorization

Find out if you need to have any medical services, such as surgery, authorized by the plan beforehand. If prior authorization before a medical procedure is required and you have the procedure done without having it authorized, your plan may not cover it and you may have to pay the entire cost.

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Use your health insurance plan

Use your plan to help cover medical costs for services, such as going for checkups, filling prescriptions, and getting emergency care. Using your benefits may help you stay healthy.

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Learn how to file an appeal
if coverage is denied

If you are denied coverage for a service that you think is covered by your plan, you may be able to file an appeal. Check your policy to find out how to file an appeal.

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Know what prior authorization
is—and how to get one

A prior authorization is a request submitted by your health care provider to your health insurance company to support your need for a specific prescription medicine. If your medicine is not covered, ask your health care provider if they will provide your insurance company with the information required for a prior authorization. This may help provide you with access to the medicines you need.

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Talk with your health care
provider’s office staff

They understand health insurance and will be able to provide advice.

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Check the SBC

Be sure to read the summary of benefits and coverage (SBC) for each plan you are considering. The SBC is a short, easy-to-understand summary of what benefits each plan covers and the associated costs. Look for a plan with benefits that match your medical needs. If you have questions about an SBC, it may help to speak to the health insurance provider.