- Private Health Insurance Coverage
- Things to Think About No Matter Which Type of Insurance You Have
- Making Your Policy Work for Your Special Needs
- Covered Services
- In-Network Provider
- Out-of-Network Provider
- Out-of-Pocket Costs
- COBRA - Extending Health Care Coverage After End of Employment
- Health Savings Account (HSA)
- Health Reimbursement Arrangement (HRA)
- Medicaid and CHIP (Children’s Health Insurance Plan)
- Does the plan allow seeking out and using specialists that you need?
- Which hospitals can you use?
- Does the policy cover the type of medicines you need?
- Does the plan cover the specific procedures and therapies you need?
- Does the plan limit the number of times per year that a certain item or procedure will be covered?
- Does the plan cover assistive technology?
- Does the policy cover assessment for mental and physical disorders?
- Is there a lifetime maximum limit on what the policy will cover?
- A deductible, which is a set dollar amount you will pay before your insurance begins to pay its percentage. You pay full price to the providers until you have reached that set dollar amount. After that, you will pay only co-insurance and co-payments.
- Co-insurance, which is your percentage after you have reached your deductible. For example, if you have 20% co-insurance, you will only pay 20% of in-network costs, and your insurance will pay the remaining 80%.
- A co-payment, which is a fixed dollar amount you pay for covered service at each visit or purchase of prescriptions. Sometimes your co-payments will count towards your out-of-pocket maximum, depending on your plan. Also, there may be a lower co-payment for generic medications.
- Out-of-pocket maximum, which is the most you will pay out-of-pocket in a benefit year for medical services. This amount includes your deductible, co-insurance, and sometimes co-payments. Once you have paid this amount, your insurance covers 100% of your in-network costs for the remainder of the benefit year.
- Eligibility - Medicaid and CHIP eligibility is determined at the state level and is income-based, so each individual and family can find their state’s policy on the Medicaid website.
- Benefits - Because Medicaid and CHIP are both administered by states, benefits vary. However, there are minimum federal care standards to be provided to all Medicaid enrollees. All Medicaid enrollees receive the following mandatory benefits:
- Inpatient hospital services
- Outpatient hospital services
- * EPSDT: Early and Periodic Screening, Diagnostic and Treatment services
- Nursing facility services
- Home health services
- Physician services
- Rural health clinic services
- Federally qualified health center services
- Laboratory and X-ray services
- Family planning services
- Nurse midwife (CNM) services
- Certified Pediatric and Family Nurse Practitioner services
- Freestanding birth center services (when licensed or otherwise recognized by the state)
- Transportation to medical care
- Tobacco cessation counseling for pregnant women
- How to Enroll - Each state has its own means of enrolling individuals and families in Medicaid and CHIP. To enroll your child in Medicaid or CHIP in your state site, go to Insure Kids Now.
- Finding a Medicaid Provider - Once an individual or family is enrolled in Medicaid, it’s important to know that every provider does not accept Medicaid coverage. Finding a doctor or hospital that accepts Medicaid can sometimes be challenging, depending on your location. Most state Medicaid websites have searchable provider lists for enrollees. Another way to locate health care providers who accept Medicaid is to call the Member Services number on your Medicaid card and speak with a representative who has up-to-date lists of providers in your area. Rhode Island Personal Assistance Services and Supports (PASS) Fact Sheet ( 196 KB) Rhode Island Cedar Family Centers Fact Sheet ( 234 KB) Rhode Island ABA Fact Sheet 2016 ( 290 KB) Rhode Island Hoja Informativa de Terapia de Analisis Conductual Aplicado 2016 Spanish ( 173 KB)
Health Insurance Marketplace HealthCare.gov
Also known as the health insurance exchange, the Health Insurance Marketplace helps uninsured people find health coverage that meets their needs and budget. Part of the Affordable Care Act.
Take Care Utah
Health insurance outreach and enrollment assistance to Utah residents. Also provides training and resources to community-based organizations that assist Utah's diverse populations and needs. All services are provided free of charge; a partnership between the Association for Utah Community Health (AUCH), the Utah Health Policy Project (UHPP), and United Way 2-1-1.
Browse states and number of government sponsored programs for each state.
Insure Kids Now
For Medicaid and CHIP (Children’s Health Insurance Program), find information on health insurance programs and dental providers in your state.
COBRA (United States Department of Labor)
The Consolidated Omnibus Budget Reconciliation Act contains provisions giving certain former employees, retirees, spouses and dependent children the right to temporary continuation of health coverage at group rates; this and linked pages explain the details of these provisions.
Social Security Administration Application Process
Disability determinations are generally made by a disability determination service (DDS) and can take several months. However, if a child has a diagnosis that provides for presumptive eligibility, a letter from the doctor certifying the diagnosis and its severity will allow for the patient to begin to receive services for up to 6 months while the application is being processed.
Utah Insurance Department
Fosters a healthy insurance market by promoting fair, reasonable and responsive practices that ensure available, affordable and reliable insurance products and services.
Tracking Medical Bills ( 125 KB)
This form, developed for Tennessee's Family Information Notebook, provides a way to track bills including dates, insurance company, who paid, and more. For a PDF version and other forms, see the Care Notebook page.
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