Health Insurance Articles

Why A Certificate Of Coverage Is Important To A Health Insurance Policy Holder

2011-08-30

Health care insurance coverage is complicated and there is a lot of paperwork involved with patient care. Some documents are important for the policy holders and some documents matter more to the insurance company. A certificate of coverage is a very important document that comes from your health insurance company. This document is for your benefit and you should read it carefully and hold onto it throughout the course of your insurance policy. Every health insurance policy has terms and conditions that apply to treatment and billing. Documents relating to the coverage tell the policy holder what exactly will be covered by the insurance company and to what extent the bills will be covered.

Coverage is very important to understand thoroughly before signing a policy. When you purchase insurance, it does not cover everything. Your certificate of coverage is a document that explains in detail what your policy does and does not cover. This document is required by law, so insurance companies have to send them out to the policy holders. The certificate describes what procedures and options your plan covers. This helps people guide their care towards things that are covered by their health insurance policy. An important part of the certificate is the part that describes exclusions in your coverage. Exclusions can vary from plan to plan and should be reviewed before you attempt to use your insurance.

This certificate has several parts that typically include a list of maximums and exclusions that you are subject to while covered by your health insurance provider. The biggest and most common exclusion is the one that states that any service that exceeds the maximum in your coverage will not be handled by the insurance company and will be your responsibility. This is usually a very high amount and not something to worry about with minor health issues. Other services that are not deemed medically necessary will not be covered by your insurance provider. If a doctor does not say that you are in need of a specific service to maintain your health, you are responsible for the expense. This most typically applies to elective surgeries and procedures like Botox.

Using hospitals and doctors that are in your insurance network is very important. A health insurance policy is only effective when you see a doctor or go to a hospital that accepts your coverage. Any other doctors will not be paid by your insurance. Each type of policy holds its own list of exclusions and conditions. High deductible plans have different exclusions than HMOs or PPOs. Read your certificate of coverage and make sure that you understand all of it. If you have any questions, speak to your insurance representative.