Minnesota Attorney General's Office
1400 Bremer Tower
445 Minnesota Street
St. Paul, MN 55101
M - F 8 am - 5 pm
Reading Your Policy-It's As Easy As 1-2-3
It seems that insurance policies get longer and longer each year. It's not uncommon today to find policies over 50 pages long. Faced with a reading assignment this big and complex it's tempting to just give up. But don't. Your policy is important. So-- dive in! Your health is worth the effort.
Fortunately, most insurance policies are put together in a similar way. Most have a "Coverages" section, an "Exclusions" section, a "Definitions" section and a "Conditions" section. By using these three steps, you can turn reading this lengthy document into a fairly manageable task:
STEP ONE-- IS THERE COVERAGE?
Start by reading the Coverages section. Does the treatment you need appear to be covered? If you encounter important terms, check the Definitions section for more information.
STEP TWO-- IS THERE AN EXCLUSION?
Next, read the Exclusions section. If you believe you have found coverage, is there an exclusion that takes coverage away? Again, refer to the Definitions section if you need terms defined.
STEP THREE-- WHAT CONDITIONS APPLY?
If you determine that there is coverage and that no exclusion takes away coverage, review the rest of the policy to determine whether any conditions apply. Conditions may include requirements that you:
a. obtain preauthorization from the health plan for a particular treatment.
b. pay a deductible or copayment.
C. use a particular health care provider.
If you are covered under an individual or group "fully-insured" policy, the health carrier must provide a copy of the policy to you. If you have coverage through an employer's self-insured health care plan, the employer must provide you with a copy of both the summary plan description and the master plan.
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