Common Coverage Questions

When does my coverage start?

If you enrolled during Fall Open Enrollment (November 1 – December 15), your new coverage starts the following January 1.

What does my plan cover?

Your plan includes all of the following and more:

  • Going to the doctor
  • Emergency care
  • Preventative care
  • Prescriptions
  • Physical therapy
  • Mental health treatment

How do I find out what doctors, services, and prescriptions my plan includes?

  • Log on to your insurer's website and look for the plan's Summary of Benefits and Coverage. It will list covered treatment and prescriptions. Every insurer provides this document for free.
  • Check the insurer's website for Doctor Look Up to see if your physician is part of their network.
  • Call your insurer and ask if your plan covers something in which you are specifically interested.
  • If your insurer mailed documents, chances are good you will find the information you need within them.

What should I do if I have a medical emergency?

  • In an emergency, always call 911 or go directly to the Emergency Room.
  • Insurers are not allowed to require pre-authorization for ER treatment, regardless of whether you seek treatment in- or out-of-network
  • You may have to pay a copay for ER treatment

What if the insurance company does not pay for a specific service or provider?

You can appeal the decision.

The insurance company will notify you to explain why they denied coverage. The letter will also indicate how to file an appeal.

Typically, you must appeal within a specific time. An independent third party reviews the claim and makes a decision.

Suppose you require an immediate decision because it risks your ability to fully function or puts your life at risk. An expedited review board can meet and make a decision within 72 hours of receipt.

How do I get my insurance card?

If you have not received your insurance card yet, make sure your plan is active and that you paid the premium.

Log on to your insurance company's website and check billing or payments. If it has not yet been paid, make a payment online or contact the insurance company's billing department.

If you have not yet received a card, contact the insurer directly. They will mail you an ID card.

Where Can I Get the Lowest Price on Health Insurance?

AARDY is the nation's fastest health insurance market. We can help you find the best health insurance plan. Our service compares Affordable Care Act and Short Term plans so you can find the best fit.


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