My Benefits Primer

Speak Up! You Have a Voice in Your Health Benefits

Making the most of your benefits means not only doing your research and selecting the plan that is best for you and your family, but also managing your plan by being aware of any chang-es and staying on top of claims and charges. Keep records of your doctor's visits, medical bills and health history. Plan for Your Health's Navigating Your Health Benefits can help.

Claim Status

ClaimClaim
Information submitted to a health plan to request payment for medical services provided to a person ... more
status

Call or check the website of your benefits providerprovider
A licensed health care facility, program, agency, physician or other health professional that delive... more
to check on your claimclaim
Information submitted to a health plan to request payment for medical services provided to a person ... more
, including the amount you owe and payment due date. Some health plans offer members a personalized web page, listing all your benefits information in one place.

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Appeal

Appealing a decision

If all or part of your claimclaim
Information submitted to a health plan to request payment for medical services provided to a person ... more
is denied and you believe this decision is in error, you may use the appeals processappeals process
A process maintained by an employer or health plan that allows an individual to appeal an adverse be... more
to initiate a review of the claimclaim
Information submitted to a health plan to request payment for medical services provided to a person ... more
. Your plan will have a process for appealing a benefitbenefit
The term "benefit" may refer in general to a health plan (your "benefits"), specifically define the ... more
decision with which you disagree. In some cases, your plan may not have had enough information to make a decision, and the appeals processappeals process
A process maintained by an employer or health plan that allows an individual to appeal an adverse be... more
gives you the opportunity to provide that information. To find out about your plan's appeals processappeals process
A process maintained by an employer or health plan that allows an individual to appeal an adverse be... more
, including any time restrictions, visit the health planhealth plan
A health plan that you buy or that is provided by your employer. It pays for health care services. I... more
's website or call the toll-free number on your ID cardID card
The identification card carried by a subscriber or dependent that provides important information rel... more
. Under some health insurance plans, the Explanation of Benefits (EOB)Explanation of Benefits (EOB)
Under some health insurance plans, an Explanation of Benefits form is provided directly to the enrol... more
form you receive after the service is per-formed includes information on the appeals processappeals process
A process maintained by an employer or health plan that allows an individual to appeal an adverse be... more
.

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Customer Sservice

Customer Service

Most plans offer toll-free phone numbers to contact the customer service department. Infor-mation can be found - and sometimes submitted - on your health benefitbenefit
The term "benefit" may refer in general to a health plan (your "benefits"), specifically define the ... more
providers' website or your ID cardID card
The identification card carried by a subscriber or dependent that provides important information rel... more

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