Dear Valued Customer,

This issue of the “—————-” is focused on how to use your new marketplace health coverage. Read on to learn more about how finding a provider, making an appointment, preparing for your first visit, and more.

The first thing you might do is read the Roadmap to Better Care and a Healthier You for tips and information. One of the important items is emergency care; now you can get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can’t charge you more for getting emergency room services at an out-of-network hospital.

We appreciate your continued business and look forward to serving you.

Kind regards,

In an emergency, you should get care from the closest hospital that can help you. That hospital will treat you regardless of whether you have insurance. Your insurance company can’t charge you more for getting emergency room services at an out-of-network hospital.

I’m having an emergency. Should I go straight to the hospital or do I need to call my insurer first?

In a true emergency, go straight to the hospital. Insurers can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.

What does it mean that insurance companies can’t charge me more?

Insurance plans can’t make you pay more in copayments or coinsurance if you get emergency care from an out-of-network hospital. They also can’t require you to get prior approval before getting emergency room services from a provider or hospital outside your plan’s network.

Will I have to pay anything?

This depends on the plan that you chose and the hospital you go to. This care may be subject to a deductible, for example, or a hospital may have particular rules in place.

Source: HealthCare.gov, “Getting emergency care.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/using-your-new-marketplace-coverage/#part=4

© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.

Now that you have health coverage, learn what you can do to stay healthy and get the care you need.

Read the Roadmap to Better Care and a Healthier You for tips and information on:

• Putting your health first

• Understanding your coverage

Health coverage pays for provider services, medications, hospital care, and special equipment when you’re sick. It’s also important when you’re not sick. Marketplace coverage includes preventive health services like immunizations for children and adults, annual doctor visits for women and seniors, screening and counseling for people of all ages, and more. The best news – it’s free.

Here are 4 things to know about your health coverage:

1. All Marketplace health plans must provide you with a Summary of Benefits and Coverage, which includes coverage examples showing how the plan might help pay for services.
2. The actual costs and care will vary by your health care needs and your coverage.
3. You can use our glossary to understand key terms like copayment, deductible, network, and premium.
4. If you have questions about your coverage, you can contact your health plan, state Medicaid program, or Children’s Health Insurance Program (CHIP) to get more information.

See why it’s so important to have health coverage and share what you learn with your family and friends.

• Finding a provider
• Making an appointment
• Preparing for your first visit
• Deciding if you like your provider
• Taking your next steps to good health

Source: HealthCare.gov, “Using coverage and improving your health.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/using-your-new-marketplace-coverage/#part”=5

© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.

.

If your health insurance company doesn’t pay for a specific health care provider or service, you have the right to appeal the decision and have it reviewed by an independent third party.

Your insurance company must first notify you in writing within a set amount of time (based on the type of claim you filed) to explain why they denied coverage. They also must let you know how you can appeal their decisions.

If the timeline for the standard appeals process would seriously put your life at risk, or risk your ability to fully function, you also can file an appeal that would get you a quicker (or “expedited”) decision. If you meet the standards for an expedited external review, the final decision about your appeal must come as quickly as your medical condition requires, and no later than 72 hours after your request for external review is received.

If you have questions, contact the Marketplace Call Center at 1-800-318-2596. (TTY: 1-855-889-4325.)

Learn more about the appeals process.

Source: HealthCare.gov, “Appealing an insurance company decision.” http://www.healthcare.gov website. Accessed December 2, 2015. https://www.healthcare.gov/using-your-new-marketplace-coverage/#part=6

© Copyright 2016. All rights reserved. This content is strictly for informational purposes and although experts have prepared it, the reader should not substitute this information for professional insurance advice. If you have any questions, please consult your insurance professional before acting on any information presented. Read more.