FOR IMMEDIATE RELEASE
December 26, 2013
What Consumers Need to Know
About Discount Medical Plans and Discount Drug Plans
Discount Medical Plans and Discount Drug Plans may be structured to look like insurance, but they are not insurance and don’t pay any of your health care costs. Instead, discount plans offer savings to plan members on various health care goods and services such as prescription drugs, doctor visits, eyeglasses, vision care, dental services and lab tests through arrangements between health care providers and the organization offering the discount plan. It is important to remember that these plans will not satisfy the requirement of the Affordable Care Act that you have health insurance. If you are looking for health insurance, Maryland Health Connection can help you shop for and enroll in a plan. To contact Maryland Health Connection, you can go to www.marylandhealthconnection.gov or call 855-642-8572. A licensed insurance producer also can help you shop for and enroll in a health insurance plan.
HOW DISCOUNT PLANS WORK
Discount Medical Plans contract with health care providers or provider networks to provide medical services at a discount to plan members. Similarly, Discount Drug Plans contract with suppliers to provide prescription drugs, medical equipment, pharmaceutical supplies and other supplies at a discount to members. Hospitals in Maryland DO NOT accept discount plans.
Discount plans must register with the Maryland Insurance Commissioner unless they are offered by entities that are licensed to do insurance business in Maryland, such as insurers, non-profit health service plans, health maintenance organizations (HMOs) or dental plan organizations.
To become a discount plan member, you may have to pay fees, dues or other financial consideration to the discount plan organization. In exchange, you get a discount on certain health care items or services, provided that you go to a health care provider or supplier in the discount plan and receive an item or service that is covered by the plan.
Each discount plan must provide a discount card to the plan member. The plan member or a member of the plan member’s family must present the card to participating providers or suppliers to receive discounted items or services. The discount card must include:
- a statement that the discount medical plan or discount drug plan is not insurance;
- information identifying the discount medical plan organization or the discount drug plan organization and/or the provider networks that participate with the discount plan; and
- the telephone number that the plan member may call for assistance.
A discount medical plan or a discount drug plan is required to notify a plan member when there is a material change in plan benefits or the information contained on the discount card. If the information on the discount card changes, the discount medical plan or the discount drug plan must reissue the discount card(s).
A discount plan must inform you before you enroll if it will keep any or all of the enrollment fees you pay if you cancel your membership within the first 30 calendar days after the effective date of enrollment.
QUESTIONS TO ASK BEFORE YOU PURCHASE MEMBERSHIP IN A DISCOUNT PLAN
- What is the fee for signing up for the plan?
- Are there any fees I must pay each time I use the discount card?
- How do I cancel the discount plan?
- Which doctors, pharmacies and other healthcare providers accept the discount card in my area?
- What specific items or services are covered and what discount is given on those items or services?
- Are there any limits on how many times I can obtain a discount on certain items or services?
- Who do I contact if I have a problem?
- Are certain conditions or treatments excluded?
- Are my current medications covered and what discount is available for those medications? (Verify that a generic brand that your health care provider says you can take is not available at a lesser amount.)
If you have a complaint against a discount plan, you may file that complaint with the Maryland Insurance Administration. For details, call 800-492-6116 or go to www.mdinsurance.state.md.us.