Health Insurance

Posted: Sun Sep 25, 2011 02:09 pm Post Subject:

Have you tried reading the "Summary of Benefits" document you were provided? (It might be called an "Explanation of Benefits" or "Outline of Coverage" -- they all mean the same thing.) It will tell you what your coverage is, what your deductibles and/or copayments are, and describe any limitations to the benefit.

If you cannot find it, then you ask the insurance company: "Can you please send me a copy of the Summary of Benefits?"

After you get it, if you still don't understand it, then you can come back here for more help or you can call the insurance company and ask whatever question you may have. You're not stupid, you just don't know.

You can also email me for assistance.

Posted: Thu Sep 29, 2011 10:22 pm Post Subject:

The primary parts of the prescription drug benefit are:

Generic Copay - the amount you pay for generic medication
Brand Copay - the amount you pay (TAYP) for brand name meds
Non-Formulary Copay - TAYP for meds that are not on the insurance companies approved list of medications (their formulary list)
Brand Name Deductible - the amount of brand name drugs you have to pay out of pocket for (at the insurance companies' negotiated prices) before the brand copay will apply.

A good set of questions is: Does my plan cover generic AND brand name prescriptions?
What are the copays for Generic? What are the copays for Brand name prescriptions? Is there a deductible for brand name prescriptions? Are non-formulary medications covered?

That should give you much of what you'll want to know.
Good Luck, and never be afraid to ask questions.

Posted: Fri Sep 30, 2011 05:45 pm Post Subject:

Thanks timit13 and MaxHerr for your replies

I have a high deductible health insurance where I am required to pay 2500 as deductible. The insurance company says I have to meet my 2500 (which is quite an amount) deductible for this fiscal year before my insurance can kick in for prescription drugs. But paying $500 for a prescription drug also seems to be quite an amount. Do I then drop the amount of deductible? I'll get back to you with the benefits of the plan soon. Thanks for all the help :)

Posted: Sun Oct 02, 2011 09:20 pm Post Subject:

MaxHerr is right, your insurance provider should have provided you with the documents titled "Summary of Benefits" or a section of the similar name.
You have every right to have them explain what exactly you will be paying for, there are representatives on line who's job is to provide you this information - you can just give them a call. These are good questions - it's really smart that you are asking them as some other people may just assume.