Health Insurance Basics

Health insurance basics
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Health insurance helps you pay for your healthcare costs including costs for preventive care. You must pay an insurance premium in order to be covered by health insurance.

Health insurance usually does not pay 100% of your healthcare costs. It is designed to share expenses with you up until a certain point, called the out-of-pocket maximum. After you hit the out-of-pocket maximum, the health insurance will pay 100% of your healthcare costs.

Keep in mind that there may be medical services that are not covered by your health insurance plan and you may be responsible for 100% of the cost.

For information about the student health insurance, please visit the Student Health Insurance page.

Tips:

  • To avoid confusion and unexpected expenses, read your insurance plan’s policy. You can start with your plan’s summary of benefits for an overview. For more details, read your plan's master policy.
  • If available, sign up for an account at your insurance company’s member website where you may check your plan benefits, claims and more.

 

TERMS YOU NEED TO KNOW

Premium is the amount you pay to the health insurance company to maintain coverage.

In Network refers to healthcare providers or facilities that are part of your health insurance plan’s network of providers with which it has negotiated a discount. You usually pay less when you go to an in-network provider.

Covered Services are the medically necessary services paid for, arranged, or authorized for you by the insurance company. Covered means that the insurance company will share the cost of the covered service, but not necessarily pay 100% of the cost.

Deductible is the amount you are required to pay out-of-pocket before the insurance company begins paying for your healthcare costs. Keep in mind, your premium and copayments/coinsurance will not count toward your deductible.

Copayment or Copay is a fixed dollar amount you may be required to pay up front for a specific type of service. For example with the student health insurance, if you are purchasing or filling a prescription for a generic medication at an in-network pharmacy, you must pay the copay of $15 up front at the pharmacy before receiving your medication.

Coinsurance is your share of the costs for covered medical services after you have satisfied any copayment or deductible, if any. It is calculated as a percentage of the allowed amount for the medical service. For example with the student health insurance, the coinsurance when you see a dermatologist at his/her private practice is 5% of the cost of your visit that you usually pay when you receive the bill.

Out-of-Pocket Maximum is the maximum amount you pay during a coverage year before the health insurance begins to pay 100% of the allowed amount for covered services.

Explanation of Benefits (EOB) is a written explanation from the insurance company regarding a claim submitted by a healthcare provider for payment. It shows what the insurance company paid and what the patient must pay. The EOB is not a bill, although it will explain any charges that the patient still owes or may have already paid. The healthcare provider will send a separate bill for the unpaid portion of the patient's share of cost, if any.

 

SEEKING MEDICAL CARE

FIT Health Services
If you are feeling ill, are seeking preventive care, have health-related questions and/or need health resources, please visit FIT Health Services at room A402 in the David Dubinsky Student Center . Regardless of what health insurance you have, you may make an appointment or walk in without an appointment during clinic hours if you are a current student enrolled for credit courses. You can make an appointment online at the student health portal .

Emergencies
If you have an on-campus emergency, contact the FIT Department of Public Safety using the red intercom installed throughout the campus or call 212-217-7777. If you have an off-campus emergency, call 911.

Outside Providers and Facilities
If you need to see a specialist (e.g. dermatologist), another healthcare provider or facility outside the campus, FIT Health Services can help you find a provider. If you already have a provider in mind, make sure the provider is in network to minimize cost.

Tips:

  • Always keep a copy of your insurance card in your wallet, your phone or both. In addition, you may save the insurance information on your contact list.
  • Always verify if a healthcare provider is in network before seeing the provider.
  • Always provide your insurance card or insurance information when seeking medical care so the healthcare provider or facility can send the bill to the insurance company for payment of the insurance company’s share of the cost.
  • Ask your healthcare provider if they have an online health portal and sign up for an account. The health portal may be helpful in keeping track of your visits, appointments, health care, bills and more.

 

PHARMACEUTICAL / MEDICATIONS

Your pharmaceutical insurance may be provided by a different company than your medical insurance company. Most pharmaceutical insurance only cover prescription medications, not over-the-counter medications.

Upon getting a prescription for a medication, there are two ways to fill the prescription:

  • Retail pharmacy are pharmacies that you can visit in person, like Duane Reade/Walgreens and CVS. Medications that you need as soon as possible, do not take regularly or do not need for 3 months or more, are usually filled at a retail pharmacy. If you take a medication regularly and need it for 3 months or more like birth control pills, we suggest requesting a mail-order prescription from your healthcare provider.
  • Mail-order pharmacy fills 3-month supply of a prescription at a time. Copay or coinsurance for a 3-month supply of medication is usually less than when filling at a retail pharmacy. The prescription is sent electronically, by mail or by fax to the mail-order pharmacy. The medications are then sent to your home. Allow 10 to 21 days to receive your medications depending on the mail-order pharmacy. Contact your insurance company for your plan's preferred mail-order pharmacy.

REFILLING OR RENEWING PRESCRIPTIONS:

If you are running out of your medication and need more, you will need to request a refill from the pharmacy or request a renewal from your healthcare provider.

Prescriptions may or may not include a number of refills. The prescription label on your medication will show how many refills you have left.

If you have refills left, contact the pharmacy to request a refill of your medication. If you have no refills left, you must consult with your healthcare provider to renew your prescription.

Each fill or refill may be subject to copay or coinsurance, if any.

Tips:

  • Save information including addresses and phone numbers of your preferred pharmacy and backup pharmacy.
  • If you take a medication regularly and need it for 3 months or more like birth control pills, we suggest requesting a mail-order prescription from your healthcare provider to minimize cost.
  • Always provide your pharmaceutical insurance card or insurance information when filling or refilling a prescription.
  • If you need a refill or renewal of your medication, it is ideal to request a refill or renewal at least 7 days before you run out. If your medications are mailed to you, it is ideal to request a refill or renewal at least 10 to 21 days before you run out.
  • If available, sign up for an account at your pharmacy’s website where you may check your prescription status, request a refill, and more.

 

PAYING FOR MEDICAL SERVICES AND PRODUCTS

For services and products that have copayment/copay, you must pay the copay and deductible, if any, during your visit or appointment.

For services and products that have coinsurance, the healthcare provider will send you a bill for your share of the cost. The bill will contain information on how to send your payment.

Tips:

  • When you receive a bill, make sure that you are being charged for only your share of the cost. Your share of the cost may include a deductible, if any. If the bill does not show any payment from your insurance and the full amount is due, ask the healthcare provider to send the bill to the insurance company first. You may also send the bill yourself to the insurance company. Once the insurance company has paid its share of the cost, you may ask the healthcare provider for an updated bill sent to you then pay your coinsurance per instructions on the bill.