Start With the Basics: Review Your Plan
First things first: Take some time to carefully review your healthcare plan. Summary of Benefits and Coverage (SBC) is your go-to resource for understanding what’s covered, what’s not, and how much you’ll pay. If you’re not sure where to find this document, ask your HR department or check your insurance provider’s website.
Pay attention to key elements like:
- Your deductible: The amount you must pay out of pocket before your insurance starts covering certain services.
- Your out-of-pocket maximum: The cap on how much you’ll spend in total for covered healthcare in a given year.
- Your network: Make sure your preferred doctors, specialists, and facilities are in-network to avoid surprise bills. Take note of the closest in-network urgent care and emergency room so you can seek care quickly if necessary.
This might feel like homework, but it’s worth it. Knowing these details helps you plan for potential medical expenses and avoid financial surprises.
Unlock Hidden Gems in Your Benefits
Employer-sponsored plans often come with perks that fly under the radar. These extras can save you money, improve your health, and even enhance your overall quality of life.
Here are some lesser-known benefits to look for:
- Free preventive care: Most employer-sponsored plans cover 100% of preventive services, like annual check-ups, vaccines, and screenings. Take advantage of these—it’s your health and your money!
- Telehealth services: Many plans offer virtual visits for a fraction of the cost of in-person appointments. A virtual visit might be perfect for minor illnesses or quick consults.
- Mental health support: Whether it’s therapy, counseling, or online resources, your plan may include mental health coverage. Some even offer free sessions or reduced copays.
- Fitness reimbursements: Some employers reimburse gym memberships, fitness classes, or even wearable fitness devices.
- Wellness programs: Check for wellness initiatives like smoking cessation programs, weight loss assistance, or discounts on health-related subscriptions.
Don’t leave benefits on the table—explore what your plan offers and start taking advantage of them.
Maximize Insurance for Routine and Unexpected Care
Using your benefits effectively requires a mix of planning and awareness. Here’s how to make the most of your coverage:
1. Stay In-Network
This one’s simple but critical: Always confirm your provider is in-network with your plan before scheduling care. Seeing an out-of-network doctor can lead to much higher bills.
2. Use Your Health Savings Account (HSA) or Flexible Spending Account (FSA)
If your employer offers an HSA or FSA, use it! These accounts let you set aside pre-tax dollars for healthcare expenses. FSAs typically have a "use-it-or-lose-it" rule, so make sure to spend your funds before the end of the plan year. HSAs, on the other hand, roll over from year to year and can even be used as a retirement savings vehicle for medical costs. Alternatively, if your employer offers Paytient as a benefit, take advantage of it! Save the tax-free dollars in your HSA or FSA and break up healthcare costs over time, interest-free instead. To learn more about these tax-advantaged accounts, check out our recent article.
3. Don’t Skip Preventive Care
Preventive care isn’t just good for your health—it’s also free under most plans. Regular screenings and check-ups can catch health issues early, potentially saving you from costly treatments down the road. Just be aware that some of these same services may cost you if you’re having symptoms that need to be evaluated.
4. Plan Ahead for Major Procedures
Need an expensive procedure? Consider timing it just right to maximize your benefits. For example, if you’ve already met your deductible this year, scheduling treatments before your deductible resets will help you save.
Beyond Insurance: Additional Employer Perks
Your healthcare benefits may go beyond your insurance card. Many employers now offer innovative tools to help you manage costs and access care.
- Health advocacy services: Some employers provide access to advocates who can help you navigate your insurance, find providers, or resolve billing disputes.
- Paytient: If your employer offers Paytient, once approved, you can use this tool to pay for out-of-pocket expenses over time, interest-free, while keeping your cash flow and savings on track. It just takes a few minutes to apply and receive your Visa card number.
- Employee Assistance Programs (EAPs): These often include free counseling, financial planning, or legal advice—all very valuable services that support your well-being!
Set Yourself Up for Success
Now that you’ve taken a closer look at your benefits, it’s time to put them to work. Research your network providers, schedule your preventive appointments, and keep an eye out for hidden perks like telehealth or wellness reimbursements.
But, don’t stop there—be proactive about asking questions. If something isn’t clear, reach out to your HR department or insurance provider. The more you understand your benefits, the better equipped you’ll be to make informed decisions and take control of your health.
With a little effort, you can make this year the one where you truly take full advantage of your healthcare benefits. Your wallet—and your well-being—will thank you.
Want to learn more? Check out our other articles breaking down health benefits here.
