When people obtain health care coverage through work, they very rarely understand the terminology used in their policy or the specifics of coverage. They may know how much comes out of their paycheck each month, or what they have to pay out-of-pocket every time they visit the doctor, but they don’t always know what medical services they may be eligible to receive, whether or not certain procedures are covered and what rights they have.

If you are unfamiliar with the terminology or details of your health care coverage, it is important you look further into the benefits and services it provides. Failing to do so could lead you to avoid necessary screenings and miss out on life-saving treatments are covered by your insurance. Do not rob yourself of the health care coverage you are rightfully owed, simply because you do not understand your policy or know your rights.

Using Government Websites to Help You Understand Your Rights and Protections Under the Affordable Care Act

Through the Patient Protection and Affordable Care Act, employees now have access to comprehensive health care coverage like never before. If you are uncertain of what rights and protections you have been afforded through your employment-based health plan, the U.S. Department of Labor’s “Consumer Information on the Affordable Care Act” page provides information on the some of the most basic protections which include:

  • Coverage for dependents up to the age of 26,
  • The prohibition of excluding those with pre-existing conditions,
  • Coverage of preventative services like immunizations, annual doctor visits for women and seniors, screenings to help detect certain diseases or conditions, and counseling for individuals of any age group,
  • Access to wellness programs,
  • Grandfathered health plans, and
  • Access to other essential health benefits.

Healthcare.gov has an in-depth glossary to help you understand some of the key terminology included in your policy such as deductible, in-network, premium, PPO, HMO, and referral. This glossary can also assist you in understanding the benefits of having a Flexible Spending Account (FSA), your rights under the Family and Medical Leave Act (FMLA), the significance of an out-of-pocket maximum or limit, and the exclusion period for those with pre-existing conditions.

Who to Contact If You Have Questions About Coverage

If you have additional questions about your specific policy or the coverage it provides, you should not hesitate to speak with your health care provider. Most health care providers have trained customer service representatives who are more than willing and able to answer all of your health care coverage questions.

Staff (63 Posts)