How to get the most from your employer health plan
While a large number of Americans enjoy the benefits of health insurance through an employer, the vocabulary and processes associated with a plan can cause a lot of confusion.
According to a 2015 U.S. Census Bureau survey, about 67% of Americans have health insurance coverage through their employer. But surveys conducted by Carnegie Mellon University researchers found evidence that a large number of Americans who are enrolled in these programs don’t understand how health insurance works.
The danger is, if you don't understand how your plan works, you might be missing out on benefits or overpaying for health care expenses.
While every employer health plan is different and benefits can vary between plans, knowing your plan-specific information is important. Access this information through your human resources representative or log in to your MyHealth account.
When you have a MyHealth account, you can take advantage of many online services:
- Online tools that can help you communicate with your doctor, schedule appointments or video chat with a provider for non-emergency situations.
- Use Find a Doctor to help you locate an in-network doctor in your area.
- Know the cost of your care based on your specific health plan with Cost Estimator. Use Cost Estimator to research costs of hundreds of medical services, whether you’re planning ahead for a procedure, or while waiting in the doctor’s office. This way, there are no surprises – you know your options and can make choices based on what’s best for you, your family and budget.
Don't have a MyHealth account? Register for one.
Decoding the cost
One of the most important things you need to understand is how the cost of your health plan benefits is shared between you and your health plan. It basically comes down to what you pay for and what we pay for. You can find this information in your plan documents, but it isn’t always easy to digest. Health insurance often seems like it has its own language.
We've tried to translate that language for you here by explaining some common terms related to health insurance costs:
This is the amount you pay each year before your health plan starts paying for the medical services included in your plan. After meeting your deductible, your plan pays a portion of the total cost for the health care services you received.
After you meet your deductible, coinsurance is your portion of the cost for medical services listed in your plan as benefits or prescriptions listed in the approved drug list.
Copayment or copay
This is the amount you pay when you receive a health care service such as a doctor's appointment. You may also have a copay when you get a prescription filled.
Your premium is the monthly amount you pay for your health insurance.
More terms used by Priority Health can be found in your summary of benefits, which is located in your MyHealth account. The summary will also include explanations of the benefits you have and examples of services included in your plan.