August 31, 2018
Making decisions about your health and health plan is easier when you understand some of the common words you’ll see. Here’s a list of five common health insurance terms, and what they mean, to help you make good decisions about your health plan:
A co-pay is the portion of your prescription that you pay for. Your health plan will pay the rest of the amount. For example, Louisiana Healthcare Connections members have prescription coverage with little or no co-pay. For members who do have a co-pay, the co-pay is never more than $3.
Sometimes, your doctor may want you to see a specialist. This is called a referral. Your doctor will coordinate this for you. Remember, Louisiana Healthcare Connections does not require a referral from your doctor for you to see a specialist, but the specialist might require a referral.
Some medical services may require a prior authorization. This means that your doctor will give your health plan information about you need the service, and your health plan will look to see if the service is covered and make sure it is medically necessary. Your doctor can tell you if a service needs a prior authorization. When our members need a prior authorization, we make the decision as soon as possible and let you and your doctor know as quickly as we can.
Preferred Drug List
Every health plan has a list of covered medications. This is called a Preferred Drug List, or PDL. It is also sometimes called a formulary. A health plan usually puts their PDL or formulary on their website where you can find it easily. You can see our PDL here.
Every health plan has a list of covered benefits. This is a list of services that the health plan will pay for. You should be able to find a list of covered benefits in your health plan’s member handbook or by calling the health plan. You can see our covered benefits in our member handbook by clicking here.