Different Types of Health Insurance Plans
There are three main types of health insurance plans available in the U.S. Under an indemnity plan, you pay a premium for the insurance, and a fixed percentage of covered expenses, plus any deductible and co-payment. You may choose your physician, and refer yourself to specialists. The University of Illinois Student Insurance program is one example of an indemnity plan. A PPO (Preferred Provider Organization) is similar to an indemnity plan. However, you pay less for care received through one of the plan's preferred physicians or facilities. Under an HMO (Health Maintenance Organization), you pay a premium for the insurance and a fixed co-payment for covered services. You must select a "primary care physician" approved by the HMO. All treatment, including that rendered by specialists and at facilities outside the HMO network, must be done on the basis of a referral by your primary care physician and must sometimes be pre-approved by the HMO. The HMO may refuse to pay for services that were not recommended by your primary care physician.
Choosing the Right Insurance Plan
As a registered student at the University of Illinois, you are automatically enrolled in the Student Health Insurance plan. You may request an exemption by providing proof of adequate alternate insurance coverage before the deadline posted on the Student Insurance web site. Your insurance must be effective from the first date of coverage of the Student Health Insurance plan. You may elect to enroll any accompanying dependents under the Student Health Insurance, provided that you are covered. Most students find that the Student Health Insurance is satisfactory. If you decide to purchase outside insurance, you should look for a plan that is both affordable and meets your needs. Cost is just one consideration. You should also understand the features of each plan. Which treatments are covered, and what is excluded? How much must you pay towards a deductible or copayment? Will the insurance pay for any medical conditions that existed at the time that you purchased the insurance? Is it important that you have access to specialists? In the case of HMO and PPO plans, is there a wide selection of primary care physicians, specialists, and hospitals or clinics affiliated with the insurance? Is there a maximum amount that the insurance will pay for each problem annually or over the lifetime of your coverage? How quickly does the company process claims? To select the best insurance, you must consider your situation and that of any dependents. For instance, if you suffer from a chronic health condition, you should avoid purchasing insurance that exempts pre-existing conditions. If you choose an HMO or PPO, find out if there is a specialist in the network who can provide treatment. Some insurance plans have very low premiums, but have high deductibles, copayments, and many exemptions. These "catastrophic" plans provide little or no benefit for most medical problems. In addition, a catastrophic plan will not meet the requirements to request an exemption from the University of Illinois Student Health Insurance plan.
Understanding Insurance Terminology
As you evaluate insurance plans, it is helpful to understand some common insurance terminology. Once you choose a plan, it is vital that you read the policy carefully to understand how your insurance company defines these terms and any others.
- Premium is the amount that you must pay to purchase insurance coverage.
- Deductible or Co-payment is the portion of your medical bill that you must pay.
- Out-of-Pocket Maximum is the highest amount that you must pay before the insurance covers 100% of the cost of treatment.
- Aggregate Maximum or Lifetime Cap is the maximum dollar amount that your insurance will pay for benefits over your lifetime or that of your insured dependents.
- Usual and Customary is the average fee that a health care provider charges for any given service in your geographic area.
- Exclusions and Limitations are benefits that are not paid for by your insurance company.
- Pre-existing Condition is any medical problem that was already diagnosed or that existed prior to purchasing the health insurance. Many plans exclude pre-existing conditions from coverage. The Student Health Insurance plan does not exclude pre-existing conditions.
- Pre-authorization is the approval that you must obtain from your insurance provider prior to treatment for non-emergency care. This is not required for the Student Health Insurance plan.
- Claim is a formal request for payment of benefits covered under the insurance program, after service is rendered and expenses are incurred.
Filing a Claim
Read your insurance brochure to find out how and when claims for benefits should be filed with the insurance company. Also ask your health care provider or hospital if they will file the claim on your behalf. If not, will they require payment for services immediately, or wait for your insurance to first pay the portion of your bill as provided under your plan? Be prepared to show your insurance card to your provider at the time of service. If you purchase insurance from a source other than the University of Illinois Student Health Insurance or an HMO, ask the company to give you a claim form when you buy the insurance. Keep copies of all bills and papers related to claims for at least one year.
Using Insurance Wisely
Once you select your health insurance, it is important to use it wisely. As a student at the UIUC, you should use the McKinley Health Center and the Counseling Center whenever you can. Because the Health Service Fee that you pay along with your tuition bill covers most services, you usually do not make any additional payment. Use the hospital emergency room (ER) only in the case of a true emergency. Call McKinley's Dial-A-Nurse at 333-2700 if you are not certain whether you should go to the ER or wait to see a doctor the next day. Stay healthy. Eat a balanced diet, get plenty of rest, exercise, and have an annual physical examination. Take the time to read your insurance policy carefully before you need to use it. Your insurance company may refuse payment if you receive treatment for an excludable condition, or if you do not follow insurance protocol for treatment. Ask your health care provider for a cost estimate for any treatment you might receive, especially prior to surgery or hospitalization. Then consult with your insurance company about the coverage you might expect. By taking these measures, you can keep your health care costs down.