UNDERSTANDING & USING YOUR HEALTH INSURANCE ENROLL VIRGINIA HOTLINE:

Who is ENROLL Virginia!? Appointment Hotline: Check out where to get help! Check out upcoming events & workshops! ENROLL VIRGINIA HOTLINE:

Why have health insurance?  It’s the law! Or face a tax penalty  Ensure financial security  Prevent sickness, illness and/or injury  A medical home  Manage chronic health conditions ENROLL VIRGINIA HOTLINE:

I have Insurance……. Now What? Using Your Insurance ENROLL VIRGINIA HOTLINE:

Free Preventive Services  Well visits (1 per year)  Blood pressure & cholesterol screening  Cancer screenings  Depression screening  Diabetes screening  Diet counseling for adults with chronic diseases  HIV/STD screening and counseling  Obesity screening and counseling  Immunizations  Alcohol/tobacco use screening and counseling  Contraception ENROLL VIRGINIA HOTLINE:

Understanding Your Health Coverage  Premium  Network (In-Network vs. Out-of-Network)  Deductible  Copay  Coinsurance  Out-of-Pocket Maximum  Worst-case scenario or chronic disease care  PCP or Provider vs. Specialist ENROLL VIRGINIA HOTLINE:

“Out-of-Pocket Costs” 1 2 ENROLL VIRGINIA HOTLINE:

Different Types of Insurances HMOPOSPPO Network CoverageIn-Network only (limited choice of doctors) In- & Out-of-Network (wider choice of doctors) In- & Out-of-Network (wider choice of doctors; may cover multi-state) Primary Care Doctor (PCP)Must select a PCP when you join Not required to select a PCP Lab ServicesMust visit in-network lab only; typically only 1 available May visit independent lab preferably in-network Prescription ServicesMust visit in-network pharmacy; typically onsite May visit any pharmacy Urgent CareMust visit in-network urgent care center(s) Typically can visit any urgent care that accepts your insurance Major ServicesMust visit in-network hospitalsAny hospital (check insurance) Emergency Care (911)May visit any hospital Claim Reimbursement for Out-of- Network Not availableMust file claim Facility TypeSingle building with all services on site Generally independent offices for each doctor ExamplesKaiser Permanente, Carefirst, Anthem HealthKeepers Carefirst, Anthem HealthKeepersCarefirst, Innovation Health ENROLL VIRGINIA HOTLINE:

Scenarios Silver Plan (PPO) Deductible: $500 Premium: $175 Copays: $30, $50 Coinsurance for other services: 20% after deductible Bronze Plan (HMO) Deductible: $4000 Premium: $42 Copays: $30, $40 after deductible Coinsurance for other services: 30% after deductible Silver Plan (POS) Deductible: $200 Premium: $135 Copay: $20, $40 after deductible Coinsurance for other services: 20% after deductible Gold Plan (PPO) Deductible: $0 Premium: $265 Copays: $15, $30, after deductible Coinsurance for other services: 20% after deductible ENROLL VIRGINIA HOTLINE:

Summary of Benefits Easy-to-understand summary on your health plan benefits Helps you make an informed decision about which plan to select Goes over how much your health plan covers for each service Includes 2 common medical situations (diabetes care and childbirth) to explain how the plan would cover such scenarios ENROLL VIRGINIA HOTLINE:

Explanation of Benefits (EOB) This is NOT A BILL After you doctor visit, you will receive an EOB from your insurance company An EOB is an overview of the total charges for your visit and how costs are divided between you and your insurance company. Still not sure?  call us or visit to make an appointment. ENROLL VIRGINIA HOTLINE:

Where to Go for Care? Dial 911 if you have a life-threatening emergency Urgent Care if you have a non-life-threatening situation ◦Ex: broken arm or leg, severe cut, chopped finger, serious burn Primary Care Provider (PCP) or Physician/Doctor: ◦Well visits (one annual check-up/physical) ◦Sick visits Specialist If you have a medical condition (heart, lung, bones, etc.) that your PCP cannot treat ◦Diabetes  Endocrinologist ◦Cervical Cancer  Gynecologist ◦Heart disease  Cardiologist ENROLL VIRGINIA HOTLINE:

Preparing for Your First Doctor’s Visit Make sure to schedule an appointment in advance ◦note: if you need to cancel, be sure to call at least one day before to avoid a charge ◦ Arrive early to fill out registration forms (health privacy form, medical history form, list of medications taken, etc.) Bring your insurance card and photo ID Bring a list of your medications Pay your copay (if any) when you leave and ask for a receipt Keep your receipts and any reports in a file at home ENROLL VIRGINIA HOTLINE:

At your Doctor Visit Be honest with your doctor about: ◦Your lifestyle, family, & medical history ◦Medications - request a refill if needed or if the doctor orders one, check to see if it is a generic or brand name drug (the co-pays are different) Bring a Notebook & Pen! ◦Write down directions for taking medications or any other treatment ◦Ask Questions! ◦What is my main problem? ◦What do I need to do? ◦Why is it important for me to do this? ◦How do I see a specialist? Not satisfied? Change your PCP/provider! ENROLL VIRGINIA HOTLINE:

Next Steps After your Appointment Schedule a follow-up appointment if needed (doctor will tell you) Fill prescription if needed and follow directions carefully Call your doctor’s office:  If you experience any side effects or other problems with your medicines  If your symptoms get worse  To get results of any tests you’ve had  To explain your test results ENROLL VIRGINIA HOTLINE:

Paying your Premium 1. By mail 2. Over the phone 3. Online ENROLL VIRGINIA HOTLINE:

Paying Your Premium Online 1.Register and create an account on your insurer’s website ◦provide member ID & date of birth 2.Confirm your account via 3.Log into your account 4.Click on “My coverage & costs” or “Pay my premium” 5.Enter your payment information (credit card or checking account) 6.Submit information ENROLL VIRGINIA HOTLINE:

Online Portal  Discover much more:  Benefit details  Claims, EOBs  Find a Doctor  Out-of-pocket costs paid  Helpful Tools  Drug Pricing Tools Jessica Mercado ENROLL VIRGINIA HOTLINE:

Contact Us Enroll-Virginia Hotline: Website: Like us on Facebook: search “Enroll-Virginia” (don’t forget the “-”!) Schedule your own appointment: ENROLL VIRGINIA HOTLINE: