Health Insurance Basics 2019

Health Insurance Basics 2019


Health insurance can be confusing. Especially in the United States. Let’s review some of the basics of how health
insurance works. Just because you have health insurance does
not mean that your health care is free. There will be fees you will have to pay. At Grinnell College, all students are required
to have a U.S. based health insurance policy. The Grinnell College’s Student Health insurance
does not mail out physical cards. You can access your card, and all of your
health insurance related information, online at the United Healthcare Student Resources
app or website www.uhcsr.com/myaccount. You
will need to create a uhcsr account to access your information. Prescriptions medications have their own pricing
structure. Make sure to check your insurance company
for details. For the student insurance, prescription prices
can range from $4-$30. Prescriptions often have a generic or cheaper
version. If you are given a prescription, be sure to
ask your doctor if a generic version is available. Now we are going to go over some important
terms. Co-Pay
A copay is the amount you pay your provider at the time of services. You usually have to pay a copay each time
you to for a covered visit to the doctor. The copay for the student insurance is $10. I said covered visit. What does that mean? There are some things that your health insurance
will not cover. Some common examples: If you are sick and
go to the doctor, it will be covered. However, if you go to the doctor to talk about
acne, that visit will not be paid for by insurance. Medical procedures that are required are covered,
but elective or cosmetic procedures are not. Physical therapy is covered but not acupuncture. If you injure a healthy eye, health insurance
will pay for that. But a routine eye exam or eye glasses are
not covered. It is the same for teeth. If you injure a healthy tooth, insurance will
pay for that work, but a teeth cleaning, cavity, or wisdom teeth issues are not covered. Dental insurance is separate from the student
health insurance. Grinnell College does have an affordable dental
plan available to students. This plan is NOT included with your student
insurance. There is a separate enrollment and fee. Talk to a SHAW nurse for more information. Back to the important terms. Deductible. A deductible is the amount of money you will
have to pay before your health insurance will start to pay. Some visits have this and some do not. Routine doctor exams are usually covered by
the copay and do not have a deductible, but if you get sick and go to the doctor, you
will have to pay the deductible amount before insurance will cover the rest. This starts over each benefit period (which
are generally a year). The student insurance deductible is $150 for
in-network providers and $350 for out-of-network providers. Don’t worry, we will go over what in and
out of network means soon. An example: For a $1,000 procedure, you will
have to pay $150 deductible before the insurance will pay the other $850. Coinsurance. This is a certain percent that must be paid,
after deductible. This payment is for covered services only. You may still have to pay a copay. I know, I just used a lot of words. Here is an example: The student insurance
covers 90% of a bill (after the $150 deductible). You will have to pay 10%. The 10 % is the coinsurance. On our $1,000 procedure, you will have to
pay the $150 deductible. That leaves $850. The coinsurance that you are responsible for
paying is 10% or $85. Insurance will then pay the other 90% or $765. Remember the in-network out-of-network terms? They’re back! In-network means that your insurance has a
deal with those providers. They will pay more of those bills. You will pay less. Out-of-network providers means that insurance
pays less or NONE. And you pay more. For the student insurance, insurance pays
90% and your coinsurance is 10%. For out-of-network providers, insurance pays
70% and your coinsurance will be 30% of the bill. You can find in-network providers on your
insurance’s website. If you get referred to a doctor by a SHAW
nurse, they will try to get you scheduled with someone who is in-network. Don’t worry, they know about these terms
and will do their best to give you an affordable option! Let’s talk about the Emergency Room or ER
visits. Emergency rooms should be used for emergencies
or when no other care is available. If you have another option for care, like
SHAW or a doctor’s office, your care will cost MUCH LESS. Here’s why: ERs have their own copay. Remember for a doctor’s office, that copay
is $10? Well for the student insurance, that copay
is $150 for each visit to the ER in addition to the 10% coinsurance. If you are admitted to the hospital, this
copay is waived. Have you recently been to the doctor or another
healthcare provider? Please check your school mailbox for bills! It can take a while for the bills to be sent
as the doctor sends it to the insurance company, waits to hear from them, then is able to send
you a bill for what you owe. Unpaid bills are sent to collection agencies
and this does affect your credit score. If you are unsure about a bill or haven’t
received one yet, you can always call the doctor’s billing office or come talk to
a SHAW nurse. If you have ANY questions about bills or insurance,
you can come to SHAW for help. To review, in general, if you go to the doctor,
your bill will be $10 copay plus $150 deductible plus 10% of the charges…usually. Like I said, the United States healthcare
is tricky. For more information you can visit our website:
www. Grinnell.edu/shaw or our Facebook page Grinnell
College SHAW.

Author: Kevin Mason

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