HOW INSURANCE WORKS
“Insurance’” is a simple idea invented hundreds of years ago, although it has evolved into a complicated business. Insurance is simply a group of people sharing risk together. In health insurance, the “risk” we share is the cost of paying for healthcare, and the more we work together to keep those costs down, the less we’ll pay monthly for coverage. But if the worst happens and you need expensive heath care, you’ll want to be partnered with others that will help you pay for it.
Everyone that buys Common Ground Healthcare Cooperative insurance is joined together in ownership of our company. We don’t have shareholders to answer to and we aren’t looking to make a profit – we are only looking to help make health care easier to understand and as affordable as possible for you.
Understanding how to use your health insurance is not only important to your health, it’s your responsibility to the other members of our cooperative. You should do what you can to stay healthy, and that includes taking the medications you are prescribed and getting your preventive care (many services are provided in all our plans at no cost to you). You should also pay your bills on time and stay “in network” for care whenever possible. This is how we work together to keep costs down. The links below will you help get you started.
GLOSSARY OF TERMS
Health insurance has always had its own set of words and definitions and sometimes it can be confusing. You don’t often encounter words like premiums, copays, deductibles, coinsurance and out-of-pocket maximums unless you’re talking about health insurance. To help you understand your coverage, CGHC has developed a glossary of terms and definitions to clearly explain things.
YOUR OUT OF POCKET COSTS
Health insurance certainly pays for much of the cost of health care, but not all of it. The amount you will pay out of your own pocket depends a lot upon the plan you choose, and whether or not you see a provider that’s in our network (see below). To understand what you might be responsible for paying yourself in addition to your monthly bill (aka “premium”), click here.
YOUR PROVIDER NETWORK
If you are not covered by your employer or your spouse’s employer, you are part of the Envision – Aurora Bellin health insurance network. This network is made up primarily of providers that are part of Aurora or Bellin. To search to ensure your provider is covered, click here. If you are covered by a plan offered by an employer, click here for more information.
HOW TO SHOP FOR INSURANCE
Shopping for health insurance changed dramatically with the passage of health care reform laws. Now, everyone is approved for health insurance, and no one pays extra because of their medical history. All plans cover basic medical services. But generally speaking, you can only purchase insurance during “open enrollment” (typically November through January), and you can’t change plans during the year. So it’s important to select the right health plan from the start. Plans differ when it comes to what providers are in network, whether they will pay anything for out-of-network care (a PPO versus HMO), medications that are covered and the level of service they provide. This page can help you choose wisely if you’re in the market for insurance.
NO COST TO YOU PREVENTIVE CARE
Preventive services include routine checkups and certain screenings that can help you avoid getting sick down the road. All CGHC health plans cover certain preventive care services at no cost to you, as long as you go to an in-network doctor. Click here for detailed information on what is covered under our no cost preventive care benefit.