Health insurance benefits you may not know you have
By Tony Novak
We generally think of health insurance as coverage for doctors and hospitals in the event of an injury or illness. Yet every state requires that health insurance policies provide additional benefits for items other than acute medical care.
Federal law requires that all major medical insurance policies provide coverage to women for pap smears and mammograms given according to AMA age and frequency guidelines. This coverage must be provided without requiring that the insured satisfy a deductible or make an office visit co-payment (unless the test is combined with other medical services). Despite the universal nature of these benefits, many women are unaware of this coverage.
Health insurance policies in most states provide coverage for the treatment of long-term conditions such as alcoholism and diabetes (including expenses for self-management and testing supplies). A growing portion of insurers provide coverage for cognitive and other therapies for brain injuries and autism. Yet the National Autism Association says that relatively few people affected by these conditions are receiving long-term treatment.
Some unique health insurance benefits are wholly based on your state of residence. Arkansas residents, for example, have coverage for costs of an athletic trainer. California policies cover education and self-management programs to help with asthma. Maine residents have coverage for the removal of varicose veins, even though this is considered cosmetic surgery in all other states.
A final category of little-known benefits are provided voluntarily by employers or their insurance companies. Weight-loss programs and nutritional counseling are among the commonly offered health benefits. Counseling for pregnant women is a valuable voluntary program often offered by larger employers but generally not for the employees of small companies and those covered by individual insurance.
It seems likely that many of us have more covered health benefits than we know. The confusing matrix of benefit laws contribute to our lack of understanding of these issues.