Do you really know your health plan?

Part 1. What you need to know about your BEST Life dental or health plan

You may not know it: your health plan has been designed to help save you money. Just by understanding how your plan works can save you anywhere from a few dollars up to a several thousand dollars depending on the treatment you receive.

We have separated our tips into two parts. We really have a lot of information to share with you and want to spend enough time on each tip. With that, we will start by talking about the information your BEST Life plan already provides you:

Tip # 1 Read your Benefit Summary
Your organization may have provided you with a Benefit Summary before you enrolled. If you did not get a Benefit Summary, request one either through your Benefits Coordinator or by calling Customer Service at 1-800-433-0088.

A Benefit Summary provides a short summary of what your plan covers and is a great tool to get familiar with your plan. While you read your Benefit Summary, make sure to notice the following:

• In-network versus out-of-network:Services may be covered differently if provided by a healthcare provider contracted with a BEST Life PPO network. This type of plan is called a PPO plan. If you have a PPO plan, it is very important that you use an in-network provider. See Tip #3 for more on this topic.You have an indemnity plan if your plan does not separate benefits by in-network and out-of-network. While indemnity plans do not rely on networks, you still have the option to lower your out-of-pocket costs if you receive treatment from a provider within a BEST Life PPO network. Please read Tip #3 for more information.
• What is covered under Preventive Care: If you have a Dental or Health plan, Preventive Care will include a list of services that will help keep you healthy. Because your health can change throughout the year, BEST Life’s plans can help make Preventive Care very affordable for you and your family.
• How much does the plan cover for certain treatments: Understanding how much your plan covers for an expensive treatment will help you plan for the cost. In addition to cost, keep in mind that:
  • All of BEST Life’s dental plans require your dentist to get an estimate for any treatment that will cost over $500. (Called a Predetermination in your Certificate of Insurance.)
  • If you undergo a medical emergency, we offer case management services to ensure you receive appropriate medical attention. This service is to help avoid unnecessary or wasteful medical costs and is required for inpatient (hospital) admissions (within 24-48 hours of admission), outpatient surgeries, MRI, CAT Scans, PET Scans, nuclear imaging or transplants.
• Do you have to meet any Deductibles or pay Co-pays: A co-pay or yearly deductible may have to be met in order to access certain benefits. On PPO plans, the in-network co-pays or deductibles for will be lower than your out-of-network co-pays or deductibles.
• Are there any Exclusions and Limitations: While Benefit Summaries are great tools, they only provide a summary and may not include all the Exclusions and Limitations and other details you need to know to use your plan. Certain procedures may be specifically excluded (like cosmetic dentistry), or limited to a few times a year. Which brings us to Tip #2.

Tip # 2 Follow your Certificate of Insurance
After you enroll, BEST Life sends a Certificate of Insurance along with your ID card. This document explains how your BEST Life plan works, as well as what is covered and what is not covered.

The easiest way to read your Certificate of Insurance is to first read the sections that talk about preventive care. Then read the sections that talk about other treatment you may likely get. Always make sure to review the Exclusions and Limitations. This lets you know what treatments are not covered or how many times you may get a specific treatment.

Bring a copy of your Certificate of Insurance with you to your next appointment. That way you can refer to it when your healthcare provider suggests a treatment plan.

For Medical Plan Members Only: With the new Healthcare Reform, all BEST Life health plans have been updated with an Amendment. This Amendment explains what has changed due to Healthcare Reform. Make sure you read this, too! It explains how your health plan has changed.

Tip #3 Use a network provider
Using a network provider can really help you save on your out-of-pocket costs. Many BEST Life PPO plans provide more coverage if you go to an in-network provider. In addition, healthcare providers contracted with a BEST Life PPO network have agreed to provide services at a discounted rate. This can translate to a savings of 15% to 35% or more of what would normally be charged (depending on the plan, procedure and the area in which you live in).

Even if you are on a dental indemnity plan, it is worth looking into which PPO networks have a provider location near you. To find a network provider, look for the primary PPO network on your ID card. All BEST Life dental plans include additional access to DenteMax.

All our BEST Life health plans include access to a primary PPO network and the PHCS Healthy Directions for when you are traveling. To locate a network provider, click on the Provider Look-up link on the BEST Life website. You will need your ID card to verify your primary PPO network.

In Part 2, look for tips on why you should not use an emergency room for a cough, and useful health tools.