FAQS

A deductible is the amount of money you or your dependents must pay toward a health claim before your insurance company makes any payments for health care services rendered. For example, if you have a $1,500 deductible, you would be required to pay the first $1,500 of any claims during a plan year. The deductible excludes copayments where applicable.

Coinsurance is the amount expressed as a percentage of covered health services that you must pay after you have satisfied your plan deductible.

If you elect the Basic PPO medical plan, expect to pay a copayment for doctor’s visits, emergency room visits and urgent care center visits.

Emergency Rooms should only be used for true emergencies such as broken bones, vigorous bleeding, or severe pain – life and limb threatening conditions.

Consider utilizing Teladoc – Aetna’s telehealth option. Teladoc can be used when you need immediate care for non-emergent medical issues. It is an affordable, convenient alternative to urgent care and ER visits.

Alternatively, if your regular doctor is not available and Teladoc is not the right option for you, think about going to an Urgent Care Center. The Urgent Care Center should be used for minor emergencies (fever, cough, pain, etc.) when your physician’s office is closed, and your symptoms are too severe to wait until the office reopens or when you are out-of-town. The copayment is less for the Urgent Care Center than the ER and getting care at the Urgent Care Center will most certainly be faster than an ER visit.

The next time you are faced with deciding where to go, be sure to evaluate all your options and choose the setting that best suits your illness or injury. Of course, in a true emergency, seek the appropriate care without delay.

The maximum amount that you will have to pay for covered expenses under a plan. Once the out-of-pocket maximum is reached, the plan will typically cover eligible expenses at 100%.

An Explanation of Benefits, or EOB, is a description the insurance company sends to you explaining the health care charges that you incurred and the services for which your health care provider has requested payment. You should compare your EOB to the bill you receive from the provider. All data on your EOB should match the information that appears on the statements you receive from your provider. If it doesn’t, contact the health care provider’s office immediately.

Preventive care is proactive, comprehensive care that emphasizes prevention and early detection. This care includes physical exams, immunizations, and well check-up visits. Be sure your children get routine checkups and vaccines as needed, both of which can prevent medical problems (and bills) down the road. Also, adults should get preventive screenings recommended for their age to detect health conditions early. Remember preventive care benefits are covered 100% under both medical plan options.

The difference between generic and brand name drugs lies in the name of the drug and the cost. Generic drugs cost much less than brand name drugs, resulting in cost savings and provide the same health benefits as brand name drugs. Consult with your doctor for generic drug options. Whenever possible, request generic drugs to realize significant cost savings.

Mail order drugs are perfect for patients who take medication on an ongoing basis. Examples are high blood pressure medication, high cholesterol medication, and birth control. Mail Order drugs are convenient and have the added benefit of being shipped directly to your doorstep. Obtaining mail order drugs will reduce your out-of- pocket copay costs.

Doctors are your health advocate, yet many patients do not realize they can ask questions that pertain to their health insurance costs as well. You can ask your doctor basic questions like; “How much will my treatment cost?” “Can I be treated another way that is equally effective but less costly?” “What are the risks?” “What are the side effects?” Having a dialogue with your physician can help you better understand how his or her care decisions affect your health plan costs. It will also help your doctor get to know you better and consequently prescribe treatment that is more effective.