March 30, 2007, Newsletter Issue #70: Request The “Summary Of Benefits”

Tip of the Week

For those of you who do not have the time or patients to go through your entire healthcare benefits booklet, request the “Evidence of Coverage” (EOC) or “Summary Plan Description” (SPD). This is a “snapshot” of the plan’s eligibility provisions, events that can cause you to lose coverage, your rights to continue coverage when you or your dependents are no longer eligible to participate in the Plan, and your rights to appeal a coverage decision or claim denial and the costs. Be sure you understand these terms and conditions, particularly the “exclusions” section setting out services that may not be covered. Ask your health insurance representative to explain what you do not understand in more detail, such as the out-of-pocket maximum benefit or if there is an annual or lifetime limit on coverage.
Take note of all deadlines and procedures such as how many referrals you can get a year and when the referral expires. Familiarize yourself with the sections and keep the entire booklet in a convenient place that you can easily come back and reference as needed.

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