My Coverage Explained
It’s important to make sure you understand your health insurance coverage and how tiered networks work. After all, the more you understand your insurance and how to use it, the better you can take care of yourself or your family, right?
Tiered networks are designed to help you make smarter choices, including how much you spend on insurance. With a tiered network, your out-of-pocket costs are determined by which tier your doctor is in.
This is what a lot of tiered networks look like:
Below is an example of how tiers can help save money:
Doctor VisitCost: $200
You Pay $15
You Pay $30
You Pay $150
Specialist VisitCost: $200
You Pay $50
2-Day Inpatient Hospital StayCost: $5,000
You Pay $1,400
You Pay $2,900
You Pay $4,000
Benefit information is based on a $1,000 deductible and 90% coinsurance for tier 1, a $2,000 deductible and 70% coinsurance for tier 2, and a $8,000 deductible and 50% coinsurance for OON. These examples are stand-alone and do not track the member’s out-of-pocket max.
Tier 1 doctors and hospitals provide members care and services needed for a lower cost. As shown in the example above, you receive the highest level of benefits when you visit the doctors and hospitals in Tier 1.
Before receiving care, go online or call the number on the back of your medical ID card, to verify your provider is in Tier 1 to get the most from your benefits.
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