When most people receive their medical insurance package, they rarely read the policy from cover to cover. However, it may include lots of important and helpful information about the benefits that their health insurance policy covers.
While the Affordable Care Act covers 10 essential benefits, including emergency services and maternity care, some healthcare plans go well beyond this to provide other special benefits. Here are some surprising benefits you didn't know healthcare plans could cover.
Diet counseling was not a benefit that was covered by many health plans in the past but it is now a requirement in most basic health packages. Nearly 33 states offer this benefit as mandated by the National Conference of State Legislatures.
In addition to diet counselling, 23 states in the U.S also provide coverage for bariatric surgery as part of their health plans. This surgery involves reducing the size of the stomach and decreasing the appetite. Sixteen states in the U.S also provide benefits related to nutritional therapy and diagnosis of diabetes.
Screening For Autism
Studies by the Center for Disease Control and Prevention show that nearly 1 in 68 children suffers from an autism spectrum disorder. The Affordable Care Act has mandated that preventive services for autism disorder be fully covered with no co-pay.
This also includes autism screening, which is available at the 18th and 24th month of the coverage. Forty-three states in the U.S offer child therapy services, including autism screening, as part of their health insurance plans.
According to the American Psychological Association, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act requires coverage for mental health services as of 2008. This includes coverage for substance use disorders, behavioral health, and surgical procedures.
By law, the co-pay for psychological services cannot be higher than the co-pay for other medical services. This benefit is available in health insurance policies provided by companies with 50 or more employees and all Medicare programs.
When the Affordable Care Act was first introduced, it increased competition among the insurance companies for a majority share in the market. In order to stand out from the crowd with a unique offering, many health insurance providers began offering a fitness plan and gym membership as part of the coverage.
However, this benefit does not just include a reimbursable gym membership but also a fitness tracker to help monitor daily activity levels. Some health insurance companies also pay members for their physical activity based on the numbers reported on their tracker.
Some health insurance plans also cover hair prosthesis as part of their coverage but there is a lot of gray area in this benefit. While most benefits are mandated at a federal level, the benefit associated with hair prosthesis varies by state.
For example, wigs are not covered in the health plans at the state level but they are covered in many states. In order for the health insurance to cover the cost of the wig, the policyholder would require a prescription from the doctor.
Prenatal Supplements And Breastfeeding Supplies
Prenatal supplements are also covered under any health insurance plans as mandated by the Affordable Care Act. In addition to this breastfeeding supplies like a breast pump are also provided to pregnant and nursing mothers.
For women who may become pregnant in the future, folic acid supplements are also covered under numerous health plans. Folic acid helps prevent any birth defects in the baby. Other services like contraception pills, breast cancer screening and osteoporosis screening is also covered under many health insurance plans.
Insurance companies don't cover cosmetic procedures like a tummy tuck or a nose job but there is some coverage provided for certain reconstructive surgeries. This is when a person has been injured and physical improvements are a necessity.
Many health insurance policies cover a breast reconstruction surgery after a mastectomy along with treatment for the other breast. In many states, health insurance policies also cover speech therapy, dental treatments, and nutritional services as well.
In the United States, nearly 24 states provide health benefits for transgender-related healthcare without any blanket exclusions. Many states have also introduced laws that ban insurance companies from discriminating against treatments associated with gender reassignment.
The Affordable Care Act does not specify that gender-reassignment healthcare should be a part of the health insurance coverage but it states that it is illegal to turn away a person just because they are lesbian, gay, bisexual or transgender.
Some health plans offer chiropractic services as part of their coverage but this service also includes a lot of gray areas. Chiropractic services fall under rehabilitative services and each individual state regulates what is covered by the health insurance company.
The Medicare and Medicaid websites can provide information on which chiropractic services are covered in your state. For example, in Pennsylvania 20 visits to the chiropractor are covered but in Alabama, the services are covered up to $600.
While many health plans cover the basic needs, more and more health insurance companies are looking to offer more unique benefits that they consider a necessary treatment. One of these services includes massage therapies and cupuncture.
Many people are surprised to learn that some providers consider massage therapy a basic health service. However, this service is not covered by all health insurance plans so it is important to check with your service provider and your doctor to discuss the type of massage therapies that are covered under your plan.
When it comes to infertility treatments, 15 states in the U.S require health care plans to cover these services but each state mandates what is covered under the healthcare policy. The type of coverage falls into four categories: no coverage, coverage for infertility diagnosis, coverage for diagnosis with treatment, and full insurance coverage.
Since there is a lot of grey area surrounding coverage for infertility treatments, it is important to check with your healthcare provider to help keep your costs low and avoid any surprise bills.
An organ transplant can save a person's life, which is why many health insurance companies provide coverage for this procedure. Research shows that organ transplants are some of the most expensive treatments covered by health insurance companies. A kidney transplant can cost $263,000 while a heart transplant can cost up to $1.2 million.
Since a transplant is not a single procedure and is often accompanied by many additional costs, insurance companies offer benefits for this as well. Companies like Cigna offer up to $10,000 for the costs associated with a transplant.
The digital revolution has helped increase the efficiency of healthcare in many ways. In addition to assisting with doctors' organization of patient records, digital apps provided by health insurance companies also help customers lead a better lifestyle.
Companies like WellPoint offer health apps to help you make healthier food choices and find the price ranges for important health procedures. This helps policyholders gain access to the best health care while getting value for their money.
The best way to avoid medical problems is to lead a healthy lifestyle. Many health insurance companies have realized the importance of a lifestyle plan and are offering this service as a part of their health care package. Programs like Blue 365 and Cigna's Healthcare Rewards awards offer discounts on gym memberships and an allowance for non-medical issues as well.
These benefits may not be medically related but the aim of these programs is to improve the overall well-being of the policyholder. This can help prevent any serious health issues in the future.
Disease management is a buzzword that is thrown around by many health insurance companies. It refers to the treatment of conditions like asthma or diabetes. The range of services varies by the provider and can include blood tests and nutritional programs.
Although insurance companies use these benefits to market their services to companies, many employees are unaware that the benefits are included in their policies. You should talk to your healthcare provider to find out which benefits you are eligible for.
Mental Health Benefits
In prior years, many healthcare plans did not cover mental health services, but since 2010 many states are required to cover mental health treatments as part of their coverage. The coverage provided should be the same for other treatments like diabetes and heart disease.
Federal law also requires insurance companies to cover illnesses like schizophrenia and bipolar disorders. They should be considered equal to surgical procedures. The amount of coverage provided for mental health programs varies by state.
Companies like United Healthcare offer services that allow policyholders to save on their grocery bills. The discounts on different items change on a weekly basis and many which can save up to $50 on healthy groceries. The discounts are available in grocery stores like Giant and Shop N Save.
In addition to groceries, some healthcare plans also offer discounts on nutritional programs, gym memberships, and even select footwear as well. You can discuss these benefits with your healthcare provider.
There are many healthcare clinics around the U.S and you may even be able to find one in your local pharmacy. These clinics are incredibly beneficial if you are traveling and can't get an appointment with your regular doctor.
Places like CVS and Walmart offer walk-in services where you can receive a diagnosis on your health problem along with tests and a prescription for the required medication. Your healthcare provider can help you understand the benefits included in your plan.
Many health plans provide coverage for couples who are using reproductive technology to conceive. An IVF treatment can cost $12,000 or more and many states require that health insurance plans provide some coverage for this treatment.
This benefit covers IVF treatment and infertility treatments as well. Since coverage varies from state to state, you should talk to your healthcare provider to learn which specific treatments are covered by your plan.
Smoking Cessation Programs
Many smoking programs are now covered under the Affordable Care Act. Although most health insurance holders receive some type of coverage, the type of programs included can vary based on the type of insurance.
A basic health plan provided by the employer covers four counseling sessions for smoking cessation. This service does not require any type of co-payment by the policyholder. Smoking cessation program benefits are covered under the mental health umbrella in your health plan.