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Contents:
  1. Data Protection Choices
  2. FY 2020 Budget & Performance
  3. Get coverage information
  4. Here’s how Alaskans get their health insurance - Anchorage Daily News

So what is the best employment and financial strategy for you? What is your age?

Data Protection Choices

You might make one choice at your present age and another choice at a later date. Ask around, educate yourself, every state has a number to call to get healthcare insurance information ask for SHIP- state health insurance assistance plan. Once you calculate your medical risks, examine your finances and are choosing a healthcare policy, you need to know:. Your health insurance policy is an agreement between you and your insurance company, a contract. The policy lists a package of medical benefits such as tests, drugs, and treatment services.

The insurance company agrees to cover the cost of certain benefits which are listed in your policy. You have to pay for any uncovered medical care that you receive. What is covered is what is stated in your policy.

How Health Insurance Works

If you understand this key concept it will save you a lot of stress down the road. This concept is true for Medicare, for Medicaid and all other health insurances who set the terms rules of the insurance policy agreement that you have made with them. Some other items you need to know about your health insurance are these basic terms:. They all have different rules. Premium- If you have employer sponsored insurance this is the amount you or your employer pays for your insurance coverage.

Frequently you pay part and your employer pays part. If you are buying the insurance independently this is what you pay for your insurance. Insurance costs vary by state. Deductible- What you need to pay before your insurance kicks in. Original Medicare and many companies have an annual deductible which must be met. Some people save money on the cost of insurance premiums by buying high deductible policies. You may get denied for supplies or a service because you have not met your deductible for the year.

Coinsurance- The percent of the cost that you are responsible to pay for covered services after you meet your deductible.

Copay- This is the fixed amount of money you pay for certain services such as prescriptions or MD visits. Usually, visits at urgent care or the emergency department have higher copays. In-Network versus Out-of-Network Benefits- An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates. Accepts Medicare assignment- Means your doctor, provider or supplier agrees to accept the Medicare-approved amount as full payment for covered services.

Non participating providers have NOT signed an agreement to accept an assignment. Maximum Out of Pocket Expense- This is the maximum amount that you pay for in-network services and prescriptions in a calendar year. This includes the deductible, coinsurance and copays. For a more complete list of insurance term definitions visit this website. How well does your insurance cover your needs?

FY 2020 Budget & Performance

For example how much do your supplies cost each month and how much will you pay out of pocket until your plan coverage starts paying the bill? Is a medical necessity the same as a covered benefit? A medical necessity is something that your doctor has decided is necessary.


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A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy. Insurance companies determine what tests, drugs and services they will cover.

Get coverage information

These choices are based on their understanding of the kinds of medical care that most patients need. Learn more about preapprovals. When you receive care from providers in the network, they will process your claims directly with us, so you don't need to handle any paperwork. However, if you receive care from a non-network provider, you may have to pay the provider for the service and then file a claim with us for reimbursement. We must receive your request to review a claim within days after you receive your EOB. You can either call Customer Service or submit a written request.

If you suspect that payments were made for services you didn't receive - please call the Anti-Fraud Hotline at If you prefer, you can submit a written request so you can make a copy for your records. Along with your written request, include a copy of your EOB to identify details of the disputed claim and any other documents or information that may help resolve your claim to your satisfaction.

Here’s how Alaskans get their health insurance - Anchorage Daily News

After we receive your request, we'll send you detailed information about our appeals process, including the timeframes for each step of the process. Send your request to:. Please note: Some groups may have a different contact phone number. Please confirm your contact number on the back of your ID card before calling. For more detailed information about your benefits, see your contract or Contact Us. You also have the right to appeal any action we take or decision we make about your coverage or services.

Get additional information about how to file a complaint, appeal or request an external review. Current location: WA Alaska. Member Services. Understanding My Health Plan Please take a minute to sign in or create your account today. You'll get everything you need to use your plan and save money on healthcare, including access to: Prescription drug costs A searchable list of doctors and clinics in your network Secure email messaging with our customer service team. Personalized spending reports Claims Deductible tracking.

Covered benefits and services. To learn more about your plan benefits and services, refer to My Plan Information , Summary of Benefits and Coverage , your member booklet, or contact Customer Service. Limitations and exclusions of Premera health plans. All medical and hospital services not specifically covered in, or that are limited or excluded by your benefit plan, including costs of services before coverage begins and after coverage terminates Cosmetic surgery, except as specifically described in your member benefit booklet Custodial care Experimental and investigational procedures, services, and drugs, Implantable drugs non-contraceptive related , and certain injectable drugs, including injectable infertility drugs Infertility services including donor egg retrieval, artificial insemination, and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, and other related services, unless specifically listed as covered in your plan documents Non-medically necessary services or supplies Radial keratotomy or related procedures Reversal of sterilization Services for the treatment of sexual dysfunction or inadequacies including therapy, supplies, or counseling Special or private duty nursing.

Costs you may pay. To learn more about the costs you may have to pay, refer to My Plan Information , your benefit booklet or contact Customer Service. Find a doctor or other providers and get primary care. Finding specialist, behavioral health, or hospital care resources. Choosing the right tests and treatments. After-office hours or emergency care.

Conditions that can be dealt with in an urgent care facility: ear infections low fever or mild flu symptoms minor rashes, cuts, bites and sprain Life Threatening Call or go to the emergency room if you are in severe pain or your condition is endangering your life. Examples of medical emergencies: suspected heart attacks strokes broken bones. Out-of-area care and benefit coverage. When you are covered by Premera, your plan offers specific levels of healthcare benefits wherever you live or travel , across the country and worldwide.

Refer to your benefit booklet for details. Prescription drugs. Find a network pharmacy near you: Find an in-network pharmacy View pharmaceutical management procedures procedures that affect your drug coverage : View drugs that require Pre-approval exception requests Learn how to obtain coverage for non-drug list drugs if you have a closed drug list plan View drugs subject to Pre service review Learn what Premera does to keep costs down View your drug list and see which drugs have limitations to prescribing or access: Search drug lists with Rx Search Visit Express Scripts to view your personalized pharmacy benefits Learn how to obtain restricted pharmaceuticals: Use Rx Search to learn which drugs have restrictions, quantity limits and step therapy Visit Express Scripts to find your copay for a restricted prescription Learn about prescription mail-order.

Health plan information. Information about our utilization management program. The goal of the Utilization Management program is to promote the delivery of appropriate, effective and efficient medical care to our members. This includes medical services, medical equipment and pharmacy. Collect calls are also accepted by calling TTY and language assistance is available for callers with questions about Utilization Management. Our TTY number for deaf, hard of hearing members is Our policy prohibiting financial incentives. Information about our quality program.

Premera is committed to assuring quality care for its members. Our Quality Program makes sure that the healthcare our members receive is evaluated, measured, improved, and communicated about. The Quality Improvement Committee conducts a formal, system-wide quality assessment annually, which includes an annual program evaluation of the quality of its health services. How new technologies become covered services. Health and safety information.