Know What Your Health Plan Covers and Does Not Cover

Ask your health plan or your employer for a copy of your Evidence of Coverage. This explains your benefits and rights and how your plan works. Call your health plan if you have any questions about your Evidence of Coverage. The customer or member services phone number is on your Membership Card.

Types of Coverage:

Treatment Choices

If you have an illness, you and your doctor will talk about treatments. Your doctor should tell you all of your treatment choices, even if your health plan does not cover all of them. If you need to make an important treatment decision, ask how much time you have to decide.

• Care of Illness

Helpful Hints

Choose a Primary Care Doctor

Your primary care doctor provides you with your basic care and oversees your treatments and referrals. Ask your health plan for a list of primary care doctors. If you want a doctor who speaks a language other than English, ask your health plan for a list of doctors who speak your language. Women have the option to choose an obstetrician as their primary care physician. 

Tell Your Doctor All Your Health Concerns

Try to give your doctor as much information as you can about your health. Ask questions if you are not clear about your health problem or treatment plan.

Referrals and Prior Approval

You usually need a referral and prior approval when you need to see a specialist, such as a heart specialist (cardiologist) or a skin doctor (dermatologist), or you need a test such as an MRI or CAT Scan. Oftentimes this is called an "authorization."

Keep Your Membership Card Handy

You need to show your Membership Card to get services. Your customer or member services phone number is on the card. You can call this number any time you have questions about your plan.

Keep Records

• Keep records of your health care benefits and treatments in one place.
• Keep a list of your appointments.
• Keep records of bills or payment notices from your health plan or providers.

Make Healthy Lifestyle Choices

Health plans offer many services to help you stay well, like health education classes, weight management programs, and regular check-ups. Some health plans may offer programs to help you quit smoking. Use these Preventive Care services. Ask your doctor for more information.

Speak Up for Yourself

The best way to make sure you get good health care is to be your own advocate. Ask for what you need and know your health care rights.

Additional information

• Keeping Your Doctor - Continuity of Care
• Getting Health Care Benefits and Services