USING YOUR PLAN

Now that you have health coverage familiarize yourself with these commonly used health insurance terms as they will help you better understand your coverage.

Premium is the amount that must be paid for your health insurance or plan.

Network is the facilities, providers, and suppliers your health insurer has contracted with to provide health care services.

Deductible is the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.

• Check with your insurance plan or state Medicaid or CHIP program to see what services are covered. 

• Be familiar with your costs (premiums, copayments, deductibles, co-insurance). 

• Know the difference between in-network and out-of-network. 

UNDERSTAND YOUR HEALTH COVERAGE

• Use the emergency department for a lifethreatening situation. 

• Primary care is preferred when it’s not an emergency. 

• Know the difference between primary care and emergency care. 

• Ask people you trust and/or do research on the internet. 

• Check your plan’s list of providers.

• If you're assigned a provider, contact your plan if you want to change. 

• If you're enrolled in Medicaid or CHIP, contact your state Medicaid or CHIP program for help. 

• Have your insurance card with you. 

• Know your family health history and make a list of any medicines you take. 

• Bring a list of questions and things to discuss, and take notes during your visit. 

• Bring someone with you to help if you need it. 

KNOW WHERE TO GO FOR CARE

FIND A PROVIDER

BE PREPARED FOR YOUR VISIT

Copayment or copay is an amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor's visit, hospital outpatient visit, or prescription drug. A copayment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor's visit, lab work, or prescription. Copayments are usually between $0 and $50 depending on your insurance plan and the type of visit or service.

Co-insurance is your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

Out-of-pocket maximum is the most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit includes deductibles, co-insurance, copayments, or similar charges and any other expenditure required of an individual for a qualified medical expense. This limit does not have to include premiums or spending for non-essential health benefits.

THE FOLLOWING MEDICAL CARRIERS WILL OFFER PLANS ON NEVADA HEALTH LINK:

• Anthem (PPO & HMO)  1-877-811-3106 

• Health Plan of Nevada 800-873-0004 

• Prominence Health Plan (formerly Saint Mary's) 800-863-7515 

For more information contact us or visit healthcare.gov 800-318-2596