What’s In Your Benefit Book?

This article is intended for members enrolled in an individual health insurance plan.

In some of the emails, letters and other communications you get from us, you may notice the phrase, “See your Benefit Book for details.” That’s because your Benefit Book is specific to you. It contains details about the plan you enrolled in. Inside, you’ll find three levels of detail.

At-A-Glance

This is a single page rundown of your basic plan information, which may include:

• Who’s covered
• The plan you chose
• The network that belongs to that plan
• Your member ID number
• The dates your coverage starts and ends
• Translation and TTY info

Various Regulatory Reminders

• If you chose an HMO, there will be information about what an HMO is and how it works.
• Sometimes states require that we provide information about rights and responsibilities or assistance services to HMO members.

Get to Know Your Plan

This is a quick start guide to what your plan offers and how to use it. We cover basic information like managing your account, finding care and extra features of your plan. We point you in the right direction to learn more or get help.

Your Full Contract

Your contract provides detailed information about what your plan covers, how to use that coverage and what you may need to pay out of pocket.

It spells out what your plan covers, such as:

• Network: Your plan network and the types of fully covered providers.
• Types of care available: Visits and services covered, including preventive care, diagnostic care and treatment, and primary or specialty care.
• Limits: The number of different types of visits, services or refills covered in your plan year.
• Exclusions: Any type of provider, service or treatment not covered by your plan.