TEXAS
Now That I Have Insurance
Now that you have insurance—you should know what to expect next.
Here is some key information that will help you learn how your coverage works and how
to get the most out of your benefits.
Once you enroll in your insurance plan, you will receive
Your insurance card(s).
and other useful details.
Regular communications fro
Your Insurance Card
Your insurance card is a reference card that lists your
Here is an example of what your
ID card will look like:
copays and important phone numbers.
You willpresent your member ID card any time you
Your doctor, hospital and pharmacy use the information on
your card to verify your coverage.
If you misplace your card or need more copies, you can
request them from your insurance company. Some insurers
also offer online access to your account, where you can print
a temporary copy of your card and request new cards.
The information provided above is based on current information, should not be relied
of Blue Cross and Blue Shield of Texas a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue
Shield Association.
www.BeCovered.org
DSGNTYHITX.0417
Before you go to the doctor
Keep Your Costs Down
Get familiar with the basics of how your insurance
works. Your insurer’s website will likely have a lot of
information, as will other online resources.
If you have an HMO plan, be sure to use your primary
care physician (PCP) as your first stop for care. Your
PCP will refer you on if you need to see a specialist.
Be sure to check to see if your provider or hospital
is in your plan’s network. Visits to a provider who is
not in your plan’s network will cost you more for care.
This information will help you to better plan for out-ofpocket expenses.
Only go to the Emergency Room for a real emergency.
Before you go to your visit, make a list of questions or
concerns you would like to discuss with your provider.
Be sure to make note of all of your medications if you
are seeing a new provider or if you have changed
medications since your last visit.
After you go to the doctor
As a member, you are responsible for paying your
deductibles and copays at the time of service. Your
health insurance company will pay the balance
of your cost for medical services directly to your
provider.
If you paid out of pocket for services that are
covered, you can also submit a claim to receive
reimbursement.
You will be billed directly by your provider for services
provided outside of your plan coverage.
You will receive an Explanation of Benefits each
time you see a provider. This is a summary of what
services you received, the amount paid by the plan,
and your expected out-of-pocket costs such as
deductible, copay and coinsurance.
Paying Your Premium
If you purchased your own coverage, you will have to
pay your first premium before you can start using your
benefits. You can continue to use your insurance as
long as you keep your payments up to date.
Depending on your payment structure, you will
receive a bill for your premium:
• semi-annually
• monthly
• annually
• every other month
• quarterly
Your insurer will likely offer a number of options to
pay, including credit card payments or being drafted
directly from your checking account.
A visit to an urgent care center can save you money
in an urgent situation where you can’t wait to see
your doctor, but that is not a serious emergency
situation. Urgent care centers are able to treat
illnesses such as colds and flu, do X-Rays and treat
for minor emergencies such as minor burns, sprains,
and lacerations.
Ask for generic drugs when you receive a
prescription from your doctor. Generic drugs are
pharmaceutically and therapeutically equivalent to
brand name drugs, but cost less.
Stay in network when you make an appointment to
see a provider.
Check your Explanation of Benefits to make sure that
you were not charged for services not received.
Take care of yourself by getting preventive care,
exercising and eating right.
Helpful terms
Claim An itemized bill for services that have been provided to a plan
member, spouse or dependent.
Coinsurance Your share of the costs of a covered health care
service—usually a percentage of an eligible expense. For example, you
may pay 20% of an allowed service while your plan pays 80%.
Copayment A fixed dollar amount you are required to pay for a
covered service at the time you receive care.
Deductible A fixed amount of expenses you are required to pay
before you are reimbursed for a covered service. For example,
if your deductible is $1,000, your plan won’t pay anything until
you’ve met your $1,000 deductible.
In-Network Covered services provided or ordered by your
primary care physician (PCP) or another provider who is in
the specific network of providers that your health plan has
contracted with.
Out-of-Pocket The amount you have to pay for expenses under
your health plan. This includes your deductible, coinsurance
and copays.
Premium The ongoing amount that must be paid for your
health insurance or plan. You and/or your employer pay it
monthly, quarterly or yearly. The premium may not be the only
amount you pay for coverage. Typically, you will also have a
coinsurance, copayment and/or deductible amount.