My Coverage Explained

What Does My Health Insurance Plan Cover?

 Good news! Your health insurance plan covers a number of items and services. Most of our medical plans follow the Affordable Care Act guidelines and cover:

  • Emergency care
  • Ambulatory patient services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services

Your health plan might even offer more coverage than what is listed above. It may also have certain rules around how, when and where you can have the service or treatment. To prevent unwanted costs, it is a good idea to be familiar with your benefits.

How do I find out if something is covered by my plan?
Check Your Benefit Booklet
Your benefit booklet will outline what is and isn’t covered by your health plan. You should have received your benefit booklet in your policy kit, either by mail or email.

Contact Customer Service
Some plans don’t have benefit booklets, but there are other ways you can find out if a service, item or treatment is covered by your health plan:

Most recent update: 12/13/2017

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  • We are encouraged to have a colonoscopy done and told it is covered, but you are not told the whole story.  I had this procedure done and was told by Blue cross it was covered under my policy as a routine physical.  Not true and it cost me $2000.00, I think you should be ashamed, since they found something it was not covered, and I have to pay $2000.00 that I do not have.

  • Hi Randa, Claims are applied according to your plan's benefits for the services billed by your doctor. If your provider bills a colonoscopy as a routine service it would process according to your plan's routine benefits. If they bill the service as non-routine then your routine benefits would not apply. It is up to the provider how they bill these services.

    It's important to contact us to verify your plans benefits and important to contact your doctor to discuss how they will bill a service. ~ Kayla

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