Tips for understanding health insurance basics
Health insurance is probably one of those things you wish you would’ve learned about in high school or as part of your undergraduate degree. While insurance plans can be complex, understanding your policy is an important part of managing your health (and wallet).
If you feel overwhelmed navigating healthcare or insurance systems, you’re not alone. That’s why we’re here to help. Here are a few tips and tricks to help you understand the basics and make the most of your health insurance plan.
Why is health insurance important?
Health insurance helps cover the cost of medical treatments, appointments, mental health visits, prescription medications and other health-related expenses. Like car insurance, health insurance can provide us with a sense of security in case accidents or unexpected illnesses or injuries happen.
While you may have your own private health insurance plan, many students choose to enroll in the Anthem Gold Student Health Insurance Plan (SHIP) designed specifically for CU Boulder students.
Important insurance terms to know
It’s important to know that every health insurance plan is unique. The “rules'' for your insurance plan may be different from that of your friends. Here are a few important terms to know and look out for to help you understand and use your health insurance:
- Premium: This is the amount you pay in order to be part of a health insurance plan. If you are on a family member’s insurance plan, they are likely the one who is paying the premium. If you choose to enroll in the Anthem Gold Student Health Insurance Plan, your premium ($1,988) is paid through your tuition account once per semester.
- Deductible: This is the amount you pay for services each year before the insurance company starts paying its share of the costs. For instance, students with the Anthem Gold SHIP have a deductible of $500. This means that you are responsible for paying the first $500 worth of care you receive. After you’ve paid the full $500, your insurance company will start helping to cover expenses. Some insurance plans are considered high deductible plans, where the deductible can range anywhere between $5,000 and $10,000 per year.
- Copay: A copay is a fixed amount that you pay upfront when you receive care. Copays can apply to appointments, prescriptions or other services. Sometimes copays count toward your deductible amount, but not always. For instance, students with the Anthem Gold SHIP have a $40 copay that does not count toward their deductible.
- Coinsurance: Coinsurance means that you pay a percentage of the total cost of your medical care. For instance, students with Anthem Gold SHIP have a 20% coinsurance that starts after their deductible is met. This means that if you get an x-ray for $100, you would pay $20 and your insurance company would pay the remaining $80. Coinsurance typically applies to major medical services or expenses, like imaging, surgery, etc.
- Out-of-pocket expenses: This term describes all of the costs you pay for yourself. For instance, if you pay the cashier at the pharmacy or the receptionist when you check in for an appointment, these are considered “out-of-pocket expenses” because they are coming out of your own wallet.
- Out-of-pocket maximum: Most plans put a maximum limit on the amount of money you have to personally pay for medical expenses. For most plans, the limit can range from a few thousand dollars to tens of thousands. For instance, students with the Anthem Gold SHIP have an out-of-pocket maximum of $8,750 per year. After you meet this amount the insurance plan pays 100% of any additional medical expenses you incur. If your plan uses copays, they may or may not apply to your deductible, but they will count toward your out-of-pocket maximum.
- In-network/out-of-network: Most insurance plans partner with doctors to get better pricing and coverage for health services. Doctors and health centers that are partnered with your insurance plan are part of an “in-network” group. Doctors and health centers that are not part of this group are considered “out-of-network”. Out-of-network services usually have a separate deductible and out-of-pocket maximum that is higher than your in-network deductible/maximum. Because of this, out-of-network services often cost more or may not be covered by your insurance plan. Researching doctors, hospitals or other providers in advance can help you save money and avoid surprise bills. For students with the Anthem Gold SHIP, you have access to a very broad Anthem PPO Network.
- Supplemental coverage: Insurance plans don’t always cover everything. Supplemental coverage is designed to help cover the bills and costs that your insurance plan doesn’t pay for. CU Boulder has its own supplemental coverage program known as BuffCare. This plan is available for students who choose to use their own private health insurance plan at CU Boulder. BuffCare is designed to give you peace of mind in the event of an illness or injury by covering out-of-pocket expenses for care provided by Medical Services.
How to read your insurance card
Insurance cards are unique for each insurance company and plan. However, many of them provide similar information, regardless of what kind of insurance you have. Here is an example of what an Anthem Gold SHIP card looks like.
Front of health insurance card
Back of health insurance card
Check your insurance card for the following information. Keep in mind that your insurance card may look different than the sample listed above and not all insurance cards use the same terms or display all of the same information.
- Insurance carrier: The top of your insurance card will typically list the insurance company that your plan is provided by, such as Anthem, Kaiser, Blue Cross Blue Shield or another insurance company.
- Member ID: This number is used to identify you within an insurance system. For instance, your doctor’s office will use this number in order to bill your health insurance plan account for services. Depending on your insurance plan, this could be listed on your card as a subscriber ID or another similar term.
- Plan numbers: This section can include your group number, plan code, RxBIN and more. These numbers are used to track the specifics of your plan, so your provider can bill your insurance for in network services, out of network services, prescriptions and other expenses.
- Cost sharing: These numbers provide you with information about your deductible, copays and coinsurance, if applicable. For instance, with this insurance plan, you pay $40 for general care and specialist visits, $20 for mental health visits and a deductible of $500.
- Phone numbers: Your insurance card should list phone numbers that you can call if you have questions about finding a provider, what services are covered, billing information or general support. If you’re not sure which number to use, call Member Services and they can redirect you to the correct department.
*Some insurance information may be abbreviated on your card. For instance, Rx typically stands for prescriptions. If you are unsure about an abbreviation or any of the information above, call the member services number on the back of your card for support. You can also review your insurance plan information online through your insurance company’s website or member portal.
Additional resources and support
There are a number of resources on campus that can help you navigate health insurance questions.
Health & Wellness Administrative Services
The Administrative Services team oversees all aspects of medical insurance, billing, and medical records at CU Boulder. They can also help answer questions about health insurance, billing, or medical records.
Learn more about Administrative Services
Anthem Student Health Insurance Plan (SHIP)
If you are currently enrolled in the Anthem Gold Student Health Insurance Plan, you can learn more about coverage, benefits and more by visiting the CU Boulder health insurance website.
Learn more about CU Boulder Gold SHIP
BuffCare Program
Insurance plans don’t always cover everything. Supplemental coverage is designed to help cover the bills and costs that your insurance plan doesn’t pay for. CU Boulder has its own supplemental coverage program known as BuffCare. BuffCare is designed to give you peace of mind in the event of an illness or injury by covering out-of-pocket expenses for care provided by Medical Services.
Medical Services
Medical Services specializes in college health and is available to all CU Boulder students, regardless of your insurance plan. Students can visit Medical Services for primary care, sexual and reproductive health, physical therapy, nutrition and more. They also have a full-service Apothecary Pharmacy on site to fill prescriptions and provide over the counter medications and supplies.
Schedule a medical appointment
Counseling and Psychiatric Services (CAPS)
CAPS can help you navigate mental health coverage and help you find a local provider in Boulder that works for you and your insurance plan. You can also find mental health services based on your insurance plan by visiting Thriving Campus.