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Monthly Archives: September 2012

Why Understanding Your Health Plan Just Got a Bit Easier

Wouldn’t it be great if overnight, understanding health insurance magically became easier?

That was the aim September 23, 2012, but whether it actually happened is still in question.

On the 23rd, a new benefit from Health Reform kicked in, aimed at making it easier for consumers to understand insurance and compare plans.

It’s called the Uniform Summary of Benefits and Coverage (SBC). Right now, health plans already send you long, complicated SBCs. But the problem is, every one is different (ever tried to compare two of these?).

But now, every plan will be required to present their information in a standardized way, using the same definitions, so you can compare apples to apples.

Think of nutrition labeling—we can see instantly exactly how much more sodium is in one bag of chips versus another. That’s the goal behind the Uniform SBCs. And the “labels” actually don’t look that different from what’s on your food…

Even better, the new document also include “coverage examples,” or a theoretical breakdown of costs for some common medical conditions. See example SBCs here.

It’s a step forward, but here at Simplee, we know it’s not enough to make shopping for health insurance as easy as shopping for sweet potato chips. For example, it’s still difficult to compare 70% and 80% co-insurance when you don’t know the full cost of a service.

Basically, the new SBC will make is easier for consumers to choose between health plans, but after that, it’s still a challenge to understand claims and bills once you start using the plan.

Everyone with a private health plan will see this benefit. Look for it when you receive your plan documents each year or on your health plan’s website.



65 Free Preventive Care Benefits to Take Advantage Of

It’s been said that nothing is free – even with health coverage.

But if you’ve already paid your premiums, now is the time to take advantage of all the 100% covered benefits.

Health plans are required to completely cover 16 free preventive services for adults, 22 for women, and 27 for children. That means you won’t pay any co-pays, co-insurance, or deductibles on any of these 65 services.

Here’s how you can make the most of those free benefits.

Get your basics done.

Aim to get an all-around profile of your health with screenings or wellness counseling.

  • Breast & colon cancer screenings
  • Diabetes, blood pressure, cholesterol, STD, HPV, & depression screenings
  • Vaccines for flu, pneumonia, measles, polio, meningitis
  • Annual check-ups for women
  • Counseling to quit smoking, lose weight, stop drinking, or on HIV and STDs, domestic violence, or breastfeeding.

Here is a complete list of services.

Tell your doctor

The next time you see your doctor, mention that you want to take advantage of your preventive care benefits.

If your doctor has record of you asking about them, they’ll not only be able to start you off, but they’ll see it in their notes whenever you come in and follow-up with you.

Basically, put it on the record: You’ll be more likely to get things done when someone else is part of the plan.

Know the limits

“Free” doesn’t necessarily mean, “always free.” The key is the word “preventive.”

If you’ve had a past medical history that now requires care that would normally be free, it doesn’t count.

For example, if you had a breast cyst, a mammogram would no longer be considered a preventive care benefit.

The same thing happens if the service is aimed at diagnosing a specific illness: if your doctor orders a colonoscopy because you’re having stabbing abdominal pain, the preventive care benefit wouldn’t apply.

Check your bills

For your health plan to treat a claim as a free preventive benefit, it needs to be coded with the right medical billing codes.

For example, a mammogram for a breast cancer patient will have a different code than a mammogram for a perfectly healthy woman.

Doctors and insurance companies make mistakes, so you should review your bills to make sure you weren’t charged. If you’re billed for a service you think should be free, call your health plan or ask your doctor about it.


This post first appeared on Mint.com.