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How can I use health plan benefits to manage my condition?

People living with a chronic health condition may be able to get help from their health plans. Many health plans offer programs aimed at helping people with chronic diseases understand the day-to-day management of their condition. Some plans also offer resources to track your progress, educational material, and support from a nurse coach (usually via phone or email), to help you to take a more active role in your own health management.

Contact your insurer to find out whether they offer these types of programs and whether you qualify.

Click here to learn more about medication management and adherence.

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Glossary

Full Glossary

Actuarial Value (AV)

The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual healthcare needs and the terms of your insurance policy.

Annual Limits

A cap on the benefits your insurance company will pay in a year while you're enrolled in a health insurance plan. These caps are sometimes placed on services such as prescriptions or hospitalizations. Annual limits may be placed on the dollar amount of covered services or on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated healthcare costs for the rest of the year.