How do I determine what my health care coverage or benefits are?
Get Legal Help Today
Secured with SHA-256 Encryption
UPDATED: Feb 18, 2010
It’s all about you. We want to help you make the right legal decisions.
We strive to help you make confident insurance and legal decisions. Finding trusted and reliable insurance quotes and legal advice should be easy. This doesn’t influence our content. Our opinions are our own.
Editorial Guidelines: We are a free online resource for anyone interested in learning more about legal topics and insurance. Our goal is to be an objective, third-party resource for everything legal and insurance related. We update our site regularly, and all content is reviewed by experts.
The most important document is always the health insurance policy or the health plan service agreement; these are the binding contracts between insurers or plans and their insured or members. If you bought your own insurance, you should have a copy of the policy. You might also have a summary or brochure, which is legally known as an”evidence of coverage.”
If you have health insurance or a health plan through an employer or group, you usually do not have a copy of the insurance contract or plan agreement, but rather only has a handbook, summary, brochure or other type of evidence of coverage. In either circumstance, it is the actual insurance policy or plan agreement that controls what the coverage and benefits are, with one important exception. Generally, the law provides that evidences of coverage, whatever their form, may operate to expand or increase the coverage or benefits available, but they may not operate to decrease or limit the benefits and coverage available below that which is provided in the insurance policy or plan agreement. Therefore, if there is any question about whether a benefit or coverage is available, you as an insured or plan member should read and compare the language about the particular benefit or coverage in both the policy or plan and the related evidence of coverage.