the go-to handbook for the newly insured

Copyright Blue Cross Blue Shield of Michigan

A Guide for Navigating Your First Insurance Plan

You Have Coverage…Now What?


Whether you’re newly covered or just looking to understand your plan,

there can be a lot to digest.

We’ve gathered together the must-know details, key terms worth learning right off the bat and tools you may need for

support throughout the year.

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3Copyright Blue Cross Blue Shield of Michigan

First and foremost, why is your coverage important?


1. It’s the law.Although the health care industry is constantly evolving, individuals are still required by law to be covered under a health plan.

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2. It will help keep you healthy. Preventive services such as wellness checks, vaccinations and physicals are covered under every plan, and specialty care (like a visit with a dermatologist) is covered under most plans.

Being able to stay on top of your health without spending a lot? That’s a win-win.

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When you start to receive forms and paperwork from your insurance company and doctors, you

might notice confusing words and phrases.

Here’s what some of the common ones mean:


HMO/PPOThese refer to the two major types of health insurance plans.

If you have an HMO (Health Maintenance Organization), all of your health care services need to originate through your primary care physician. That means you need a referral before seeing a specialist (except in an emergency).

A PPO (Preferred Provider Organization) gives you more flexibility. You can go to any health care professional you want without a referral (although it might cost a lot more if you go to one out of your network).

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http://www.mibluesperspectives.com/2014/06/08/a-guide-to-referrals-for-hmo-members/

http://www.mibluesperspectives.com/2014/06/08/a-guide-to-referrals-for-hmo-members/


PremiumThe monthly amount you or your employer pays to your health care company to keep your coverage.

Health insurance premiums are typically paid every month to an insurance company for health coverage. Think of it like a gym membership – it’s what you pay to be a member and can vary based on what’s included and covered.

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DeductibleThe amount you owe for covered health care services before your health care plan begins to pay.

The fees for health services that you pay throughout the year go toward your annual deductible. Once you’ve met your deductible, you share the cost with your plan by paying coinsurance and copays up until total benefit maximum.

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CopayA fixed amount you pay for a covered health care service, usually when you get the service.

A copay for a scheduled doctor visit typically ranges from $25 to $50 based on the type of plan you have and is paid for during the time of the visit, rather than billed later.

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Explanation of Benefits (EOB)An EOB is a way to simply see what services your medical care insurance pays for, services not payable by insurance and why, and any charges you may owe for services received.

For example, if you go to the dermatologist and get a skin cancer screening, you’ll receive an EOB mailed to you shortly after your appointment outlining what procedure you received, how much your insurance covered and how much (if any) you’re responsible for paying out of pocket.

An EOB is not a bill. Your care provider (doctor, hospital, clinic, etc.) will send you a bill if you owe money. You can access your EOB at any time through your member portal or mobile app.

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HSA/HRAThese two terms refer to accounts that can help you pay for medical services.

Health Savings Accounts (HSAs) are similar to a 401(k) retirement account, but for your medical expenses. You put away a certain amount of money pre-taxes, and you can use that fund for medical costs. Health Reimbursement Arrangements (HRAs) are similar funds that are set up by an employer. This fund is used to reimburse employees for medical expenses not covered by your health plan.

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http://www.mibluesperspectives.com/2015/03/25/what-is-an-hsa/


If you ever feel a little lost or confused, there are also resources

and tools available to help.


These helpful tools include:• The Blue Cross Find a Doctor Tool helps you locate convenient physicians and specialists

who are covered under your plan

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http://www.bcbsm.com/index/find-a-doctor.html?utm_source=MyBluesPrespective&utm_campaign=GA_101259&utm_medium=Social_Media


• The Blue Cross Find a Doctor Tool helps you locate convenient physicians and specialists who are covered under your plan

• The Blue Cross mobile app enables you to see your coverage and plan details wherever you may be

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These helpful tools include:


http://www.bcbsm.com/content/microsites/app/en/index.html?utm_source=MyBluesPrespective&utm_campaign=GA_101261&utm_medium=Social_Media



who are covered under your plan• The Blue Cross mobile app enables you to see your coverage and plan details wherever

you may be• 24/7 online health care covers online doctor’s visits under certain plans, powered by Amwell

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http://www.bcbsm.com/index/health-insurance-help/faqs/topics/getting-care/online-visits.html?utm_source=MyBluesPrespective&utm_campaign=GA_101260&utm_medium=Social_Media

http://www.bcbsm.amwell.com/




you may be• 24/7 online health care covers online doctor’s visits under certain plans, powered by Amwell• MI Blues Perspectives.com is Blue Cross’ blog, designed for Blue Cross members and other

Michiganders; posts contain information on all things related to health care coverage, brand updates and events

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http://www.mibluesperspectives.com/






• Customer Action Center is available whenever you have a question or comment—just drop us a line and our member services team will follow up with you directly

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http://www.mibluesperspectives.com/customer-action-center/







• The Blue Cross Member Portal is your go-to location to sign into your account, check your claims and update any personal information. All it takes is a few clicks.

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https://member.bcbsm.com/mpa/simplelogin/







• The Blue Cross Member Portal is your go-to location to sign into your account, check your claims and update any personal information. All it takes is a few clicks.

• Ever wonder if you’re getting the most out of your health plan? Our Member Tools page has a handy quiz and tons of great references for learning more about your health care.

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https://member.bcbsm.com/mpa/simplelogin/

http://www.mibluesperspectives.com/membertools


Want to learn more?

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