It’s confusing, it can be pricey, and there are several household chores you’d rather do, than deal with it… It’s your health benefits. But don’t worry, you can do this. Consider this your health benefits 101.
Health plans utilize provider networks. Your health plan has negotiated rates for health care services that are considered “in-network.”
Networks consist of select providers or hospital systems and the doctors and clinics associated with those systems. There are often performance agreements and quality standards that an in-network provider must meet.
In-network health care services cost you less. When you use in-network health providers and services, your out-of-pocket costs are not as expensive as using out-of-network providers and services.
Examples of out-of-pocket costs include deductibles, co-insurance, and copays.
Why is it this way?
When an insurance carrier aligns their coverage with a network, that network provides the carrier with a discounted cost per service.
Since the discount can be anywhere between 10 to 40 percent of the retail cost, the health plan passes some of the savings on to you in the form of lower out-of-pocket costs, and no balance billing.
Which providers are in-network?
A list of in-network providers is often available from your health insurance company.
Unfortunately, you cannot always rely on network provider listings on the internet to be up-to-date. Just as you can change your job, a health care provider can change its arrangement with an insurance company. Therefore, it is important to always directly confirm with the provider that they are a network provider for your health plan, before receiving services from that provider.
When you use an out-of-network provider, that provider may “balance bill” you. Balance billing means that the provider sends you an invoice for any costs the insurance carrier determines it won't pay. Insurance carriers determine a “reasonable and customary” charge for every service. Any charges above reasonable and customary are often billed back to the patient through balance billing.
An in-network provider is not allowed to balance bill the patient and must accept the contracted rate as payment in full.
When in doubt, ask questions.
For any given health situation, it is important to find out whether ALL your providers providing care for your particular health concern are in-network. This includes the individuals who treat you, as well as the location of your health care services.
When in doubt, ask questions. Health care providers are there to serve you. They can answer questions about your network and health plan coverage.
Providers not necessarily in one particular network include:
- Mental Health services
- Ambulance (or other emergency transport service)
- Dialysis Centers
Thinking about taking out that trash? Hold up, we’re almost done here!
Figuring out your health plan can be tricky. There can be a lot of information to deal with. But, the more general concepts that you know, the better equipped you will be. Empower yourself to make educated choices!
Decisions such as choosing a health care provider that’s in-network can save you hundreds or thousands of dollars. Proceed confidently when making decisions about your health care. You don’t have to be an expert, just ask the right questions. Health Benefits 101 can give you a hand with the basics. Recognizing your needs and options will prep you to deal with any decisions that come your way.
But wait, there’s more. This is a general description of in-network, but that doesn’t cover everything about your plan. Check your Summary Plan Description (SPD) from your health insurance company. It contains what you need to know about the specific rules of your health plan.
If you want to know about any plans or services we provide, please access your Employee Benefits Corporation plan’s Summary Plan Description (SPD) and other helpful information by logging in. Just click the “Log In” button in the upper right corner of this page, then “Participants.” There you will find the specific rules for your BESTflexSM Plan health care flexible spending account (FSA), EBC HRASM health reimbursement arrangement (HRA), or SimplyHSA health savings account (HSA). These benefits give you ways to save pre-tax money on your health care expenses.
You can also log in to access helpful information about your CommuteEase pre-tax parking and transit benefits, as well as information for those who use COBRASecure. Not sure what plans you have? You can log in at the top of the page (www.ebcflex.com) to see all your current plans, or ask your employer.