1. Skills for Independent Living: Volume III - Health
A Guide To Insurance
What You Need To Know
6/12/2018
Skills for Independent Living: Volume III - Health

2. What is Health Insurance
Your health insurance policy is an agreement between you and your insurance company. The policy lists a package of medical benefits such as tests, drugs and treatment services. The insurance company agrees to cover the cost of certain benefits listed in your policy. These are called "covered services."
Your policy also lists the kinds of services that are not covered by your insurance company. You have to pay for any uncovered medical care that you receive.
6/12/2018
Skills for Independent Living: Volume III - Health

3. What Is a Medical Necessity?
Insurance companies provide different kinds of insurance at different costs.
Keep in mind that a medical necessity is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary. A medical benefit is something that your insurance plan has agreed to cover. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.
Insurance companies determine what tests, drugs and services they will cover. These choices are based on their understanding of the kinds of medical care that most patients need. Your insurance company's choices may mean that the test, drug or service you need isn't covered by your policy.
6/12/2018
Skills for Independent Living: Volume III - Health

4. What Should I Know About Insurance
Your doctor will try to be familiar with your insurance coverage so he or she can provide you with covered care. However, there are so many different insurance plans that it's not possible for your doctor to know the specific details of each plan. By understanding your insurance coverage, you can help your doctor recommend medical care that is covered in your plan.
Take the time to read your insurance policy. It's better to know what your insurance company will pay for before you receive a service, get tested or fill a prescription. Some kinds of care may have to be approved by your insurance company before your doctor can provide them.
If you still have questions about your coverage, call your insurance company and ask a representative to explain it.
Remember that your insurance company, not your doctor, makes decisions about what will be paid for and what will not.
6/12/2018
Skills for Independent Living: Volume III - Health

5. What If Something I Need Is Not Covered By Insurance?
Most of the things your doctor recommends will be covered by your plan, but some may not. When you have a test or treatment that isn't covered, or you get a prescription filled for a drug that isn't covered, your insurance company won't pay the bill. This is often called "denying the claim." You can still obtain the treatment your doctor recommended, but you will have to pay for it yourself.
If your insurance company denies your claim, you have the right to appeal (challenge) the decision. Before you decide to appeal, know your insurance company's appeal process. This should be discussed in your plan handbook. Also, ask your doctor for his or her opinion. If your doctor thinks it's right to make an appeal, he or she may be able to help you through the process.
6/12/2018
Skills for Independent Living: Volume III - Health

6. How Do I Get Health Insurance?
Usually, you can get health insurance one of three ways:
Through an employer (your job)
Through the state – Medicaid
Through the county – Hillsborough County Healthcare
6/12/2018
Skills for Independent Living: Volume III - Health

7. Health Insurance From An Employer
Most adults over the age of 18 are covered under an employer sponsored plan. It is to your advantage and your responsibility to understand how these benefits work and your rights under these benefits.
6/12/2018
Skills for Independent Living: Volume III - Health

8. Health Insurance Through Your Employer
Your options are important.
There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer's human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your health care decisions will be.
Review the benefits available.
Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
6/12/2018
Skills for Independent Living: Volume III - Health

9. Health Insurance Through Medicaid
What is Medicaid? Medicaid is a federally-funded, state-run program that provides medical assistance for individuals and families with limited incomes and resources. It pays for your health care costs, including doctor's visits and eye care
What does it cover?
Doctor and dentist services
Clinic and hospital services
Nursing home and home health care
Family planning services; Prenatal care
Pediatric care
Mental health care
Prescription drug coverage
Optometrist services and eyeglasses.
6/12/2018
Skills for Independent Living: Volume III - Health

10. Skills for Independent Living: Volume III - Health
How Do I Get Medicaid?
Qualifications are different from state to state. You can qualify if one or more of the following statements are true:
You have children and a limited income.
You receive or are eligible for Supplemental Security Income (SSI).
You're a pregnant woman who meets income requirements. For example, a family of four making $23,225 a year or less qualifies.
Your family's assets are less than $2,000.
You receive adoption assistance or foster care assistance.
6/12/2018
Skills for Independent Living: Volume III - Health

11. How Do I Apply for Medicaid?
Contact your local Social Security, Welfare, or Department of Human Services office. Find your local Social Security office or call (800) for more information.
6/12/2018
Skills for Independent Living: Volume III - Health

12. Health Insurance Through Hillsborough County
Hillsborough Healthcare is a comprehensive managed health care program funded by a special sales tax and administered by the Department of Health and Social Services. Hillsborough HealthCare has four networks providing primary care at several clinics strategically located in the County.
There are hundreds of participating referral specialists in the networks, as well as a full array of diagnostic and hospital services. Hillsborough HealthCare also covers prescriptions, vision, dental, home health and other medically necessary services.
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Skills for Independent Living: Volume III - Health

13. Hillsborough Healthcare (cont)
Hillsborough HealthCare is designed especially for residents of the County whose income is at or below the federal poverty level and who have no other medical coverage. For example, a single person can have an annual income of $9,800 or a family of four, an annual income of $20,000.
There are no premium payments for Hillsborough HealthCare; however, there are some member co-payments for certain services such as prescriptions.
For more information, contact Health and Social Services by phone: (813)
6/12/2018
Skills for Independent Living: Volume III - Health