Insurance Basics: Home

Getting Covered

There are three main sources of health coverage. The first is your job. The second is a plan that you buy. The third is a government program for older, disabled or low-income

Getting Covered
Benefits for People with Disabilities

A disability is a health issue that limits what you can do. There are public and private sources of benefits for children, adults and veterans with disabilities, and their caregivers.

Benefits for People with Disabilities
Explanation of Benefits (EOB)

After you get care, your provider sends a bill, or “claim,” to your insurance company. Your insurance company handles the claim and sends you an Explanation of Benefits (EOB).

In-Network and Out-of-Network Care

Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.

If Your Plan Doesn't Pay (Appealing a Reimbursement Decision)

Suppose your insurer won´t pay for a healthcare service, or pays less than you had expected. You have the right to “appeal”, or ask for your case to be formally reconsidered.

Having More Than One Health Plan

Being covered under two health plans doesn't mean the two plans will pay the same amount twice for the same doctor visit. Instead, the plans follow rules about which plan pays what, known as "coordination of benefits."

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IN AND OUT OF NETWORK

When Out-of-Network Care Can Be Covered in Network
PLAN COSTS

Flexible Spending Plans
YOUR RIGHTS

Appealing a Reimbursement Decision
KNOW BEFORE YOU GO

Choosing Your Healthcare Provider In-Network and Out-of-Network Care