Understanding guidelines of your health insurance plan

After you have chosen a health insurance plan, you can follow their instructions and guidelines. But it is necessary that you understand their guidelines clearly before opting for any health insurance claim. The insurance policy details provided to you by your company will contain the guidelines of their policy.

 Health plan – guidelines

Some of the guidelines as stated by the health insurance plan include:

  • The health policy will show the list of medical services and benefits that it covers. It will also give a list of illnesses or services that it does not cover.
  • There will be rules regarding the selection of doctors and hospitals like the case with managed health care plans. In this the healthcare companies are tied up with certain doctors and hospitals who agree to provide medical care to their patients and the company pays for them as they are their customers. Such medical providers are the doctors or hospitals in the health plan’s network.
  • They also provide rules related to the selection of physicians or specialists that are not in the health plan’s network.
  • The stated rules also mention about any special medical service that you would like to obtain, maybe which is more expensive. They have different rules for such services and you can follow them.
  • Another important aspect includes the expenses of drugs that are covered by your health plan. They may provide you with a list of drugs and the related guidelines regarding their prescription and other formalities.

Tips for you

With all the information that you have, it is important that you go through them and use them when required. It is important to know your health plan very well before opting for medical service. Here are a few things you can do:

  • You need to read and understand all the guidelines and instructions carefully.
  • You can talk to your doctor about your health plan, the illnesses covered under them. They should also know about the medical benefits, services and the prescription drugs that are covered under your health policy. The policy may also mention certain medical investigations that they cover. This too needs to be discussed with your doctor.
  • Learn about the formalities regarding claiming for a medical service. Some companies have specific norms related to this. For example, you may have to send intimation to them before getting admitted to the hospital or a prior notice is required before undertaking a medical service, etc.
  • If required, talk to the company executive and get your doubts cleared and make a note of it.
  • Keep all the policy papers, insurance identity card safely and carry them whenever required.

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