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:

Prescription Co-pay

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.

Referral

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.

Prior Authorization

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

The Louisiana Medicaid Single Preferred Drug List (Fee For Service and Managed Care Organizations) is a list of drugs Louisiana Medicaid members can use if prescribed. All Healthy Louisiana Medicaid health plans, including Louisiana Healthcare Connections, follow this PDL.

The PDL applies to drugs you get from retail pharmacies. The PDL is not a complete list of covered drugs. It lists the preferred medications in the most common drug categories.

You can view the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) (PDF) online.

Covered Benefits

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.