Insurance Basics: Home

In-Network and Out-of-Network Care

Your plan contracts with a wide range of doctors and other practitioners, as well as hospitals, labs, radiology facilities, pharmacies and other providers. These are the providers in your “network”. Each of these providers has agreed to take your plan´s contracted rate as payment in full for services.

In-Network and Out-of-Network Care
Code Modifiers: How they Affect You

Doctors and insurers use standard codes for each medical service or supply. That helps them communicate about treatments and payments clearly.

Code Modifiers: How they Affect You
Flexible Spending Plans

Flexible spending plans let you set aside money from your paycheck. You can use it to pay for care before meeting your deductible, and for copays and coinsurance afterward.

Narrow Networks

Health plans negotiate the price of medical services with certain doctors, hospitals, labs and other providers.

If Your Plan Doesn't Pay (Appealing a Reimbursement Decision)

Suppose your insurer won´t pay for a healthcare service, or pays less than you had expected. You have the right to “appeal”, or ask for your case to be formally reconsidered.

Limited Health Plans: AHPs and STLD Plans

New rules have expanded access to two types of limited health insurance plans. They are association health plans (AHPs) and short-term, limited duration (STLD) health plans. Because they don’t have to follow the Affordable Care Act, these plans can cost less than regular health plans. But, they have limitations you should know.

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