Consumer-Driven Health Plan (CDHP)

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Consumer-Driven Health Plan (CDHP)

This type of plan is fairly new on the health care scene. It lets you set aside a certain amount of money in a special health insurance savings account. You are in charge of how you use this money to cover your health care costs. However, the deductible you have to reach is usually higher than in the other types of plans.

It may seem odd buying something that you might never need. Just consider it an investment in your peace of mind. Since peace of mind means less stress, you'll start enjoying health rewards right away!


Health Insurance: Cracking the Code

Health insurance has a language all its own. Here are some words you'll need to know:

· Claim: A detailed explanation of medical services that you or your doctor must submit to the insurance company in order to be reimbursed.

· Coinsurance: Similar to a co-payment except that instead of paying a fixed amount, you pay a percentage of the total cost. (Example: You have surgery that costs $5,000. You might have to pay 20%, or $1,000, while your health plan pays the other 80%, or $4,000.)

· Co-payment (or co-pay): The portion of the bill you are responsible for each time you receive a service. (Example: When you go to the doctor after you've reached your deductible, you may no longer have to pay the full $100; instead you may pay a $25 co-pay, while your insurance picks up the other $75.)

· Coverage limits: This means your health plan may stop paying once you reach a certain annual or lifetime maximum dollar amount.

· Deductible: The amount you must pay out of your own pocket before your insurance company will start paying for services. (Example: If you have a $500 deductible per year, and each doctor's visit costs you $100, your insurance may not kick in until you've been to the doctor five times.)

· In-network provider: Any doctor, hospital, or other provider of medical services that has agreed to be in your insurance company's network and to offer their services at discounted rates. Also called a participating provider. (Compare with out-of-network provider, below.)

· Non-covered services: Services that are not covered under your insurance policy, which means you will be responsible for all charges if you choose to get them. Examples of services that are frequently not covered include cosmetic surgery, chiropractic care, and alternative therapies like acupuncture.

· Out-of-network provider: Any doctor, hospital, or other provider of medical services that has not set up special rates with your insurance company. If you choose to use an out-of-network provider, your insurance may not pay as much toward that appointment — or your visit may not be covered at all. You have to pay the difference (or the entire fee) out of your own pocket. (Compare with in-network provider, above.)

· Out-of-pocket maximum: This is the dollar amount that your portion of health care costs cannot exceed each year. (Example: If your annual out-of-pocket maximum is $10,000 — and you have doctor's visits, procedures, and medication co-pays that have gone over that amount — your insurance will cover any further claims at 100%.)

· Policy: A contract between an insurance company and an individual that provides coverage for health costs in exchange for a set payment.

· Precertification: When you need to let your insurance company know in advance about any medical tests or procedures the doctor has ordered. If your insurance company requires precertification and you do not do this before receiving treatment, the procedure may not be covered.

· Pre-existing condition: Any injury or illness that existed before the date when your current policy started. Pre-existing conditions may not be fully covered.

· Premium: The amount you pay to the insurance company each month to buy health coverage.

· Primary care doctor/primary care physician: A doctor (usually a family practice or internal medicine doctor) who coordinates all your medical care, from annual physicals to referring you to specialists.

· Referral: When your insurance company requires your primary care doctor to authorize any visits to other doctors or specialists. If you don't get a referral, your visit may not be covered.

· Usual, customary, and reasonable: Terms that refer to the amount typically charged by health care providers for similar services in the area you live in. (Example: Your dermatologist charges $200 for an office visit, but most other dermatologists in your area charge $150. Your insurance company may reimburse based on a charge of $150.)



How to Fill a Prescription

There are lots of small but significant responsibilities you take on as you become an adult: Doing your own laundry. Making sure you keep the gas gauge off "E." Filling a prescription.

OK, so maybe that last one isn't one of the first things that come to mind. Still, it is an important step toward independence. It means you're starting to take responsibility for your own health care.

In the Doctor's Office

The prescription process starts in the doctor's office or at the health clinic. Tell the doc if you're taking any medications — even over-the-counter (OTC) or herbal medicines. With some medications, there's a risk that one might cause problems with the other (known in the medical profession as an interaction). For example, certain prescription medications can make birth control pills less effective.

Speaking of birth control, your doc will probably ask about birth control or whether you use alcohol or drugs. It may seem awkward to talk about these topics, but your doc needs to know if you've taken anything that might interact with the prescription medication. Don't worry, though — your doctor isn't there to judge you or report back to your parents. Many doctors find a way to speak privately with teen patients so they can share confidential information. So don't hesitate to talk openly.

Your doctor may hand you a written prescription to take the pharmacy of your choice. Lots of docs submit prescriptions electronically, though — in which case your doc will ask which pharmacy you'd like to use.

If you're away at school or you'll be traveling, you might want to fill your prescription at a large chain pharmacy. Most chains use one prescription database for all their stores, allowing you to pick up prescriptions at different stores in the same chain.

Before you fill your prescription, find out if it's covered by insurance. Some medications may not be. For example, your insurance company may not cover certain acne medications or your doctor may have to contact the insurance company to get these approved. If that's the case, you'll want to know so there are no surprises at the pharmacy.

Picking Up Your Prescription

If your health insurance covers prescriptions, take your prescription card to the pharmacy. When you first fill a prescription, the pharmacy staff might ask you to leave your card for a while so they can verify your insurance.

The staff will probably ask if you have questions for the pharmacist or ask you to sign a waiver if you don't. Now's your chance to ask any questions you might have thought of since leaving the doctor's office — such as the best time of day to take your medication, whether it needs to be taken with food, etc.

If the pharmacy seems busy or you don't want to ask about something personal in front of other people, you can always call the pharmacy and ask to speak to the pharmacist after you leave. Mention that you just filled your prescription there and you have questions.

Your prescription may come with an information sheet from the manufacturer, and probably one from the pharmacy too. These offer useful information on how best to take that particular medication and also any side effects to watch out for.

If you notice any side effects while taking a medication — even if you think they're not serious or important — let your doctor know. And don't hesitate to turn to your pharmacist for advice, too. Pharmacists are trained in the science of how medications work and can offer lots of useful advice.



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