Your benefit rights
State and federal law require some health benefits to be in all insurance plans.
Before you sign up or your employer adds you to a plan, the plan must tell you the following:
- What benefits it covers, including prescription drug coverage
- Any limits to coverage
- How it protects your privacy
- Your premiums and other costs
- How to appeal a decision or ask an outside group to review a claim
- How much you need to pay for services (e.g. copayment, deductible or coinsurance)
- What providers and locations it covers
Your right to access care and providers
- Your health plan must let you choose from a list of primary health care providers. If necessary, you can change providers. Your plan should also include access to every type of licensed medical provider.
- Your health plan must quickly refer you to specialists who can help you. If you have a complex or serious condition, your plan may refer you for multiple specialist visits.
- If your plan covers chiropractic care, it must allow you to visit a chiropractor.
- Your plan must include women's health care.
Your appeal rights
You can appeal any claim your health plan denies. The process should be quick, fair and unbiased. To find out more, check out our appeals guide.
Your privacy
Health insurers and your providers can't share your personal health information unless you give them written permission.