Surprising ways your health plan works for you

April 13, 2026

You're likely familiar with the basics of your health plan’s coverage, such as doctor visits, hospital stays, and prescription medications. But there are many ways your health plan works for you, including some you may not even know about! From care management to pharmacy services, there are many functions that help you receive the care you need.

Let’s take a closer look at five key operating functions of your health plan, and how they work together to support your health and well-being.

Care Management: Coordinating your care

Care management is the process of coordinating your care across different health care providers and services if you have an ongoing health condition or have an urgent need. This might include scheduling appointments, managing medications, and supporting you if you’re experiencing increased symptoms. Having a care manager can help reduce your need for emergency or hospital care and ensure your care is aligned with your health goals. Care managers also consider social determinants of health, such as if you have enough to eat, a safe place to live, or transportation challenges, to help understand the root causes of health issues.

Pharmacy services: Managing your medications

Pharmacy services are an essential part of your health plan. By working with a pharmacist or other health care professionals from your health plan, you can get the support you need to manage your medications effectively.

The appeals process: Resolving disputes

Approximately 84%* percent of all health care claims are processed without an issue. But sometimes, you may experience a dispute. The appeals process is designed to help resolve these disputes in a fair and efficient manner. Log in to your online member account to find out about our appeals process.

Mental health resources: Supporting your mental well-being

Your physical health goes hand in hand with your mental health. Mental health is just as important as physical health, and your health plan may offer a range of resources to support your mental well-being. Log in to your online member account and select Find & Get Care to search for a therapist or mental health provider.

24/7 support

Harnessing the power of AI, chatbots and virtual assistants provide health plan members with 24/7 support and guidance, helping to improve member engagement and satisfaction.

By understanding how your health plan operates, you can get the most out of your coverage and ensure that you receive the care you need. Remember to:

• Review your health plan documents to understand the operating functions of your plan.
• Contact your health plan's customer service team to learn more about these functions.
• Take advantage of these functions to support your health and well-being.

*Source: Premier National Survey on Payment Delays and Denials, Q4 2023