Your Medical Coverage—What You Need to KnowYour Medical Coverage—What You Need to Know

We already mentioned how important it is to understand your health care plan. As you’ve probably discovered over the years, it is the types of services that are not covered by your health care plan that can cause financial stress. 

By now you might be aware of the types of services and medical needs your child requires now, and may require in the future. If you aren’t, though, speak with:

  • Your doctor
  • Other health care professionals you work with
  • Disability-specific organizations
  • Other parents

Try to get a feel for what types of medical services your child may need in the future so you can determine whether or not your health care plan covers them. Knowing this will help you adjust the “Anticipated Amount" on your spending plan. For whatever medical needs your health care plan does not cover, consult with your Parent Center and your disability-specific organization for what assistance might be available to help you pay for them.

It might also be helpful to speak directly with the following people, depending on your plan, to get absolutely clear on the services your plan covers and what your financial responsibilities are:

  • A Human Resource Department employee who oversees your employer-provided health care plan or group health insurance policy.
  • A health care plan customer service representative.
  • Your insurance agent.

When you have this conversation, have the following information available in case you need to refer to it.

  • Your Summary of Benefits.
  • Any Explanation of Benefits (EOB) that you think will be helpful during the conversation.
  • A list of your child’s medicines.
  • A list of the types of specialists who care for your child.
  • The types of procedures and therapies your child needs.
  • A list of anticipated services or medicines your child might need.

During your conversation, use the following linked form to document some of the details of your health care plan’s benefits.



Health_care_plan_review_pdf Health_care_plan_review_Excel File


 As you get to know your health care plan and its benefits, the Medical Plan Features chart linked below will help you further analyze them. The chart includes questions you can ask your health care plan representative to help you learn more about your health care plan.



Medical_Plan_Features_pdf Medical_Plan_Features_Excel File



“There is an art to navigating the health care system, and it is one you can learn. Ask for case managers in the hospital and with the insurance company, and then work at developing a good rapport and working relationship. You have to be willing to ask questions and keep on asking questions until you understand. That is your right. It is what you have to do.” —Carolyn Allshouse, parent advocate, mother of Jack