Coverage to Care

Table of Contents

Understand your Plan & Benefits | Find a Provider | Know Where to Go for Care | Coverage While Traveling | Make an Appointment | What to Expect After Your Appointment | Take Care, Stay Well | Still have Questions?

Understand your Plan & Benefits

Having health coverage is an important first step to better health and well-being. the most from your plan.

Your health coverage can help you pay for things like visits to the doctor, prescription drugs, hospital care and emergency room visits, and tests or treatment for health conditions such as diabetes and heart disease. Plus, all Vermont Health Connect plans include free preventive care services such as immunizations (for babies, kids, and adults), routine check-ups, screening tests, and lots more!

Be sure that you understand what services and providers your plan will pay for, and how much each visit or medicine will cost.

Your insurance company or group health plan must provide you with a Summary of Benefits and Coverage (SBC) or Handbook that outlines the key features and costs of each plan. Ask them for a copy or look for a link online.

You will get a card as proof of your health insurance—usually about two to four weeks after you pay your first bill. The letters and numbers on your card help you and your health care providers understand your benefits and costs. It also includes phone numbers for your insurance company, so make sure you keep it handy.

Find a Provider

Finding a primary care provider you trust is one of the most important decisions you’ll make about your health. Whether you need a routine check-up or special care because you’re sick, your primary care provider (also called a PCP) can help make sure you get the medical care you need. Emergency room visits are expensive, so having a PCP can help you with your medical needs and save you money in the long run.

Most health plans provide you with a “network” of doctors and other health care providers. If you see a provider in your network, the insurance company will pay for their share of the cost. If you see a provider outside of your network, and it isn’t an emergency, you usually have to pay most (or all) of the cost yourself.

Click here for links to your insurance carrier’s Provider Networks.

Know Where to Go for Care

Although you can get medical care in many different places, it’s best for you to get routine care, check-ups, and recommended preventive services from your primary care provider.

Not all doctors and facilities take all insurance plans or types of coverage.

If you can, call your insurance company or the doctor’s office before you go to make sure they accept your health insurance (or find out how much you will have to pay). In an emergency, you should get care from the closest hospital that can help you.

Health insurance companies can’t require you to get prior approval before getting emergency care from a provider outside your plan’s network. And they can’t charge you more for going to the emergency room at an out-of-network hospital.

Coverage While Traveling

If you get sick or injured when you’re traveling, Vermont Health Connect plans will cover any urgent care you may need, but you may be responsible for out-of-pocket expenses. If you see a provider and it isn’t an emergency, you will usually have to pay most (or all) of the cost yourself.

An Urgent Care Center can be a good—and affordable—option if you need medical care and your doctor’s office isn’t open. Look online or in a local phone book to find locations near you.

Make an Appointment

When you call for an appointment—especially if it’s your first visit—you should have your insurance card or other documentation handy. You should let the staff know the reason you want to see a provider, if there’s a particular provider you prefer to see, and if you have a specific need (like requiring an interpreter or an accessible exam table).

Here are some other things you can do to be prepared for your visit:

  • Ask if there are any forms you should fill out before your visit, if you need to bring anything with you (like medical records or a list of current medications), and what you should do if you need to cancel or reschedule your appointment.
  • Know your family health history and make a list of any medicines you take.
  • Bring a list of questions and things to discuss, and a pen/pencil and paper to take notes with during your visit.
  • If you have a co-pay or co-insurance payment due at your visit, be prepared to pay it.
  • Bring someone with you to help if you need it.

What to Expect After Your Appointment

After you visit your provider, you may receive an Explanation of Benefits (EOB) letter from your insurance company. This is an overview of what services you received, the total charges for your visit, and how much both you and your health plan will have to pay. An EOB is not a bill. While an EOB may show what you owe, you will get a bill separately from your doctor’s office. Contact your insurer if you have questions about your EOB.

Take Care, Stay Well

After meeting with your provider, it’s important to follow their instructions. For example, follow through with any referrals to specialists and schedule a follow-up visit with your PCP when recommended.

Most importantly, if you have questions or concerns between appointments, call your doctor’s office.

Still have Questions?

We’re here to help! Call our toll-free hotline at 1-855-899-9600 with questions about what your plan covers, how to find a provider, or what you need to do next.