Health Plans 101: The basics of your LifeWise health plan

Confused about how health plans work? You’re not alone. Studies show that more than half of adults in the United States experience raised eyebrows and squinty eyes when reviewing healthcare insurance options and plans. 

A better understanding of the basics of healthcare insurance plans can help. Let’s dive in and clear up some mysteries. 

Fundamentally, healthcare insurance plans break out into three main categories: care networks, plan benefits, and costs for care.

Care Networks

Care networks are made of providers who offer all types of healthcare services, from primary to specialty care. In the health insurance world, providers are either in-network and out-of-network. 

In-network providers have negotiated agreements with insurance carriers for care and costs to help drive comprehensive care and more savings for members. Out-of-network providers have no such agreements with your insurance carrier.  As such, using out-of-network providers may result in additional costs for care.

Plan Benefits

Benefits are the health products and services within your plan and are listed in the Summary of Benefits found in your online account. Your plan benefits include: primary care, emergency care, mental health care, specialty care, pregnancy care, and prescription medication. Health insurance plans vary from person to person, so it’s important that you review your personal plan information on your account. 

Check out this helpful video that lists 10 essential health benefits that are required on all plans by the Affordable Care Act. 

Costs for Care

Here’s where things get tricky for many people. Products and services are priced and applied in healthcare in a manner that’s unlike most other industries.

There are, generally, three cost components that work (sometimes together) to determine how much you will pay for care, deductibles, coinsurance, and copays. 

Deductibles

Most health insurance plans feature a deductible, which is a set amount of money a health plan member will pay (out of pocket) for care services before insurance starts to pay. That set amount can vary between plans and can be influenced by the size of your monthly premium payment. With most plans, a higher monthly premium will lower the set deductible amount. Conversely, a lower monthly premium payment will raise the deductible amount. 

Coinsurance

Once your deductible is satisfied, coinsurance begins. Coinsurance is the percentage of the costs for care shared between you and your insurance carrier. As an example, and again after you’ve met your deductible, if your plan calls for LifeWise to pay 70 percent of the cost of covered care, you pay the remaining 30 percent. 

Copay

Regardless of whether you’ve met your deductible, a copay may be charged for an office visit, for example, $35. Money you put to a copay will also be applied to your deductible. 

Check out this video to see how the math works for deductibles, coinsurance, and copays. 

Can deductibles, coinsurance, and copays add up to a lot of money? Sure they can. That’s why all LifeWise plans include an out-of-pocket maximum. Once you hit that ceiling, LifeWise pays 100 percent of your coverage for care. Again, check your Summary of Benefits on your account to see your out-of-pocket maximum.  

To make sure healthcare is affordable while you work to meet your deductible, LifeWise plans feature many low-cost and fully covered services. Preventive care, including annual preventive visits, screenings, and vaccines are often covered at no extra cost to you. See your plan for other low-cost benefits and services.  

Have more questions about your plan or benefits? Our knowledgeable customer service representatives are ready with answers. Call 800-817-3056 Monday through Friday, 8 a.m. to 6 p.m.