Skip to main content

Assessing a Plan’s Network in Three Steps 

The quality and extent of a health plan’s provider and health care facility network can be a central factor in deciding whether to stay with a health plan or to find a new one. It’s important to have access to the care you need from providers you want while still protecting your budget.  

During Open Enrollment, we recommend you assess your health plan’s network. Does it still work for you? How does it compare to other plans’ networks? Answering these questions may take a little time and research but will give you confidence in your health plan decisions.

Let’s Start with Definitions

In health insurance language, a network is a collection of providers and health care facilities who contract with a health plan to provide services to members at a rate that is less than their usual fees.  

When you get care from an in-network provider or use an in-network facility, you save money. Conversely, out-of-network providers and healthcare facilities are providers and health care facilities that do not contract with your health plan. Generally, you pay more when you go out-of-network. 

Common Terms

Bookmark this blog that defines common health insurance terms to help guide you as you assess and make your decisions this Open Enrollment.

Three Steps to Assessing a Network

Your comfort in seeking and receiving care is very important. Take time to make sure you’re getting the best care you can while still protecting your budget. Following the below three-step review will help you evaluate a plan’s network and if it can allow you to do just that. 

1. Confirm Certifications and Quality Ratings 

When it comes to entrusting your health with a provider, you can’t be too careful. Find out if your provider is a board-certified doctor at CertificationMatters.org. A doctor that’s certified by the American Board of Medical Specialties (ABMS) has: 

  • Earned a degree from a qualified medical school.
  • Had 3 to 7 years of accredited residency.
  • A license from a state medical board.
  • Passed one or more exams administered by a member of the ABMS.
  • Continuing education requirements.

Next, look into your provider’s quality ratings. The National Committee for Quality Assurance (NCQA), for example, measures provider and health plan quality and recognizes high-quality through certain programs. Their goal is to help consumers — like you — find the best care and coverage available. You can search to see if your providers have received NCQA recognition. Do you need to see a specialist? The American Board of Medical Specialists certifies many different specialties and subspecialities that you can verify online.  

2. Word of Mouth Reviews

Standardized quality measurements give you empirical data to make decisions on. However, there’s a lot to be said for other patient reviews. Getting opinions from others on a provider can give you an insight into the more intangible qualities of a physician, like bed-side manner, the office’s customer service, appointment availability, and more. Start by asking your friends, family, and coworkers for recommendations. Then, take the search online to find other patient reviews at: 

3. Out-of-Network Benefits

Evaluating your plan’s network also means understanding the flexibility it offers—including how it supports care outside the network when needed. There may be times when you need to get care from an out-of-network provider or facility. To find out if someone is out-of-network, you can call their office to ask what health plans are accepted or contact The California Schools VEBA Advocacy Team at 888-276-0250 for assistance. 

You can still seek care out-of-network, but you may need to be prepared for the financial impact of that choice. For most plans, if you go out-of-network, you will likely pay more. Some plan types will not cover out-of-network care at all while some cover only a portion of the costs. Look in your Summary of Benefits and Coverage (SBC) to see what your current plan covers or in the SBC of other plans to compare this benefit.  

Supporting You Now and Next Year

During Open Enrollment, take the time to evaluate your plan’s network and how it has worked for you in the past year. Determining the right network coverage is a balancing act of access to top quality and controlling costs. We’re here to help if you have any questions. Call The Advocacy Team at 888-276-0250 or visit CalVEBA.org/Contact.

CalVEBA Resources

MyVEBA Portal

We’re excited to launch our new MyVEBA Portal. Get started with our new MyVEBA Portal here.

Benefit Contacts

For assistance with specific carrier benefits or issues, such as claims or coverage details, visit CalVEBA.org/Benefit-Contacts/.

Get Support

The CalVEBA Advocacy Team is here to assist with health care navigation, including appointment scheduling and quality of care. Call 888-276-0250 or visit CalVEBA.org/Contact for assistance.

If you find this blog helpful in understanding health insurance terms, be sure to check out the other blogs in this series for more in-depth information and insights into the world of health care. 

Is Your Health Plan Still Right for You? 5 Key Things to Check 

A lot can happen over a year. Your health, budget, life situations, and more can all change. Open Enrollment is a great time to reassess your needs and ensure your current health plan meets them. As you prepare to make your selections for coverage, use this checklist to help you see if your current health plan is working for you, your health, and your budget.

Here are five key health plan areas to check: 

1. What’s Covered 

Coverage, in health insurance terms, is the costs from your medical services and prescription drugs that your health plan pays. What and how much is covered under your health plan can change from year to year, and what you need covered can also change. For example, having a baby, getting married, getting divorced, and major changes in health needs, all can impact the type of health plan you need.   

Your health plan gives you a Summary of Benefits and Coverage (SBC) each year. This document is an easy-to-understand overview of benefits and coverage provided by your health plan. Before you make your choices, it’s a good idea to review the SBC through the lens of your needs now rather than what you needed a year ago. If you need help finding a copy of your plan’s SBC or understanding it, we’re here to help. CalVEBA members can access their plan information online at .

2. How Much Are Your Costs?

Take a moment to review your total health care costs over the past year. Were there any costs that were higher than expected? Are there any trends? Consider whether you anticipate these trends to stay consistent, rise, or decrease. If you anticipate needing more care next year and expect higher expenses, it’s important to determine if your current plan effectively manages those costs. Additionally, if your financial situation changes, your current plan may become unaffordable for you.  

When looking at health care costs, remember, there’s more to the total than monthly premiums. Total costs of care over the year include monthly premiums, deductibles, copayments, coinsurance, and out-of-pocket maximums. (Read this blog for definitions of these terms.) Review your expenses for each category over the past year to determine if your current plan meets your budget needs. Consider any anticipated increase in care for the upcoming year as well. 

3. Is Your Care Team In-Network?

Selecting your care team — a team of health care professionals like primary care providers (PCP) and specialists that you choose to go to for care — is a personal decision. You need to feel comfortable with them as a person and confident in them as a professional.

When selecting providers and facilities, ensure they are within your health plan’s network. By choosing in-network providers and facilities, that have contracted agreements with health plans and offer services at reduced rates for plan members, you can save money. 

If you’re not happy with your providers, get recommendations from friends and family and then check if they are in-network for your health plan. Your comfort in seeking and receiving care is very important. Take time to make sure you’re getting what you need from your care team while still protecting your budget with your plan’s network. 

4. What’s the Customer Service Like?

During this time of year, reflect on your experience with your health plan carrier. No company, system, or process is perfect, but you deserve the totality of your experience to work for you.

Have an issue with your health plan carrier you need assistance with? Reach out to The CalVEBA Advocacy Team here or call 888-276-0250. 

5. What Prescription Drugs Are Covered?

Health plans may include prescription drug coverage. You can find what’s covered and how much in your plan’s formulary or list of covered drugs. You can access this formulary on your health plan’s website, by contacting your health insurance provider directly, or reviewing the documentation provided to you when you enrolled in the plan. If you take prescription drugs or anticipate being prescribed any soon, you’ll want to review this list as coverage and costs may change year to year. 

Remember, it’s important to take your medication as your doctor prescribed — at the right times and in the right amounts. Don’t stop your medication without talking to your provider. Take this time to thoroughly review your prescription drug coverage and what that means for your health and your budget. It may still work for you, or you may need to pick a different plan for next year.

Eating for a Heart Healthier You

Heart-healthy eating doesn’t have to be complicated or restrictive, and caring for your heart isn’t about one big change, but the small, everyday choices that support your long‑term health.

You don’t have to give up the foods you love. Making simple swaps and practicing mindful eating can make a big difference in your heart health. Below, you’ll find simple ways to start building heart-healthy habits.

What is Heart-Healthy Eating?

Heart-healthy eating is a proactive approach to lowering the risk of heart disease, heart attack, and stroke. Embrace a plan that works for you! Here are some ways to start making small changes:

  • Prioritize fruits, vegetables, whole grains, beans, and high-fiber foods. 
  • Incorporate lean proteins such as seafood, lean meats, beans, nuts, and soy products. 
  • Avoid saturated and trans fats, limit sodium, and alcohol, and reduce added sugar intake. 

How to Get Started

Begin by reflecting on what truly matters to you. Your personal motivations will be the driving force behind your commitment to heart-healthy eating. Explore your feelings about change and identify both the challenges and positive aspects. Draw inspiration from past successes, times when changes were easier, and apply that wisdom to your current journey.

Celebrate every small victory, whether creating a grocery store checklist, meal prepping, or opting for a healthier substitute—each positive change contributes to your overall success.

What Does Heart-Healthy Eating Look Like?

Choosing a heart-healthy diet doesn’t mean you need to say goodbye to your favorite recipes. Small modifications can make a big difference! Opt for heart-healthy choices by making small substitutions, like choosing:

  • Avocado oil or olive oil instead of shortening or margarine
  • Fat-free milk over whole milk
  • Lean proteins, such as ground turkey or extra-lean beef
  • Low-sodium alternatives or enhance flavor by replacing salt with herbs, spices, or lemon

5 Recipes for a Day of Heart-Healthy Eating

Healthy eating starts with food choices. You don’t have to be a chef when it comes to creating nutritious and heart-healthy meals for you and your family because the Resource Center’s Chef Leslie has got you covered! Here’s a sample day of heart-healthy meals you can try:

Visit our Recipe Library for more inspiration and easy substitutions/modifications for heart-healthy eating.

The Heart of the Matter

Small changes lead to big results. Start today and make heart health part of your everyday life. Your heart health is an investment in lifelong wellness filled with flavorful possibilities!

Visit The California Schools VEBA (CalVEBA) Cooking & Nutrition Hub to help you make informed choices about your dietary and lifestyle choices, supporting your journey towards better health and well-being.

The Resource Center offers many Cooking & Nutrition Classes. Join us to learn how to blend the art of food and cooking with the science of medicine to optimize your overall health and wellness – all while having fun! Check out our calendar to sign up for an upcoming class.

Do You Feel It In Your Gut?

There’s lots of buzz about gut health and how you can improve it, but probiotics alone are not the cure-all for gastrointestinal (GI) issues, as some may believe.

Probiotics are live microorganisms, often referred to as ‘good’ bacteria, that can provide health benefits when consumed in adequate amounts. They help balance the gut microbiome, support digestion, and can help improve some gastrointestinal conditions.

Probiotics

However, probiotics are considered safe for most people — except for people who are significantly immunocompromised — and may be worth using if they help with mild to moderate GI symptoms. 

More ways to help common GI symptoms include: 

  • High-fiber foods for people with symptoms of hemorrhoids or digestive conditions. 
  • Hydration and fiber for those with constipation. 
  • Avoidance of food triggers, such as caffeinated beverages, for people with reflux symptoms. 
  • General healthy lifestyle choices, including eating well, exercising, and avoiding tobacco and alcohol can also help. 

The Power of Protein & Fiber

While probiotics can be beneficial, incorporating adequate amounts of protein and fiber into your diet is essential for maintaining a healthy gut. Together, protein and fiber contribute to a healthy digestive system, supporting overall gut health and function. Your goal should be to aim for at least 10 grams of protein and 5-8 grams of fiber for your first meal.

Start Strong: Easy Options to Begin Your Day

  • An extra egg (96 grams of protein)
  • A scoop of protein powder (15-25 grams of protein)
  • ½ cup of Greek yogurt (10-12 grams of protein)
  • 4 ounces of tempeh (22 grams of protein)

Your gut plays a key role in your overall health and vitality. Take the first step towards better gut health with our Gut Check Toolkit. From lifestyle tips to delicious, gut-friendly recipes, it has the tools you need to nurture your digestive system and thrive.

Download The Toolkit

When to get help 

Unlike other organ systems, the GI tract can be taboo. Few individuals like to talk about their colon and bowel issues. However, it’s important to feel comfortable enough to discuss your digestive issues with your doctor so that you can find treatments to address potentially serious concerns. 

Symptoms that may indicate more severe GI tract problems include: 

  • Chronic diarrhea 
  • Rectal bleeding 
  • Black, tarry stools 
  • Unexplained weight loss or rapid weight gain 
  • Jaundice 
  • Iron-deficiency anemia 
  • Severe abdominal pain 

Talk with your doctor if you have new or concerning symptoms. Additionally, it’s important to get GI screening tests done at the proper age, such as colon cancer screening at age 45 for those who are at average risk.

Visit The California Schools VEBA (CalVEBA) Cooking & Nutrition Hub to help you make informed choices about your dietary and lifestyle choices, supporting your journey towards better health and well-being.

Not sure what preventative screenings you should be getting at your age? Download this infographic! 

Read this blog to learn more about colon cancer prevention. 

Learn about nutrition and holistic ways you can support your gut microbiome in CalVEBA’s Cooking & Nutrition classes led by Chef Leslie and Healing through Natural Medicine classes led by Dr. Ioanna Vouloumanou (Dr. V.) DAOM, LAc. Visit the class calendar to sign up for these educational classes.

This blog includes content from Sharp Health News, a publication of Sharp HealthCare.

Sleep and Your Mental Health

Dalai Lama

“Sleep is the best meditation.”

Getting a good night’s sleep isn’t just about feeling rested—it’s central to your mental and overall well-being. The National Sleep Foundation reports that over 90% of American adults with good sleep health experience minimal depressive symptoms.*

Healthy sleep enhances mood, regulates emotions, and improves concentration for better well-being. This post offers simple strategies to prioritize sleep so you can feel and function your best, starting tonight!

Getting your zzz’s

Why Sleep Matters

Even one night of poor sleep can reduce resilience and impair cognitive function. Quality sleep reduces stress and anxiety, improves focus, and increases empathy. If you have insomnia, the risks are even greater for developing serious mental health conditions. People experiencing sleep issues — including insomnia, hypersomnia (excessive sleepiness), and nightmares — have an increased risk of depression, suicidal ideations, and death by suicide.

Dreaming of Better Sleep?

Creating good sleep habits starts at home. Your daily routine, from the moment you wake up to what you eat and how you move, all contribute to better sleep.

Six Tips for Better Sleep

Take Control of Your Nights

1. Stick to a Schedule

Go to bed and wake up at the same time every day, even on weekends, to regulate your body’s internal clock (circadian rhythm).

2. Watch Your Intake

Steer clear of nicotine, caffeine, alcohol, and heavy meals close to bedtime.

3. Soak Up the Sun

Aim for 30 minutes of natural light in the morning to help set your sleep-wake cycle.

4. Stay Active

Exercise daily, but wrap up your workout a couple of hours before bed to allow your body to cool down and prepare for sleep.

5. Create Comfort

Keep your bedroom cool, dark, and quiet. Consider using a white noise machine or fan, use room-darkening-curtains, and maintain a temperature between 60 and 67 degrees.

6. Put Down the Devices

Reduce screen time at least one hour before bed. Studies show exposure to your phone’s blue light suppresses melatonin production (the hormone that regulates sleep).

Drift into Sleep: Meditation App & Classes

Apps like Calm and Headspace offer daily mindfulness and meditations to relax, release stress, and sleep better.

Check out our calendar and sign up for an upcoming meditation class at the VEBA Resource Center (VRC) or visit the on-demand video library for classes such as Yoga Nidra (Yoga for Sleep)

Sweet dreams! Here’s to better sleep, brighter days, and restful nights that support your mental health and enhance your well-being.

Bonus tip:

Wind down by bathing, reading, or listening to this 2-minute Simple Meditation.

*Source: National Sleep Foundation (2023, March 9). The Link Between Our Sleep Health and Mental Health. Sleep in America® Poll 2023. 

Easy Acupressure Techniques for Stress Management

Peter G. Hanson, M.D.

“Stress is simply the adaptation of our bodies and minds to change.”

Whether it’s the daily pressures of work, personal challenges, or simply the fast-paced nature of modern life, stress can take a toll on our well-being. Fortunately, there are simple, effective ways to find relief and restore balance. This blog will guide you through easy acupressure and self-massage techniques you can use on-the-go to manage stress and cultivate a sense of calm whenever needed.

Techniques & Benefits

These techniques combine the benefits of acupressure and self-massage to calm your nervous system, release tension, and manage stress effectively.

Hand Pressure Point for Tired, Achy Hands

  • Benefits: Relieves hand fatigue and pain.
  • Location: Web of muscle between the thumb and index finger.
  • Technique: Press your thumb and index finger into the web of the muscle between the thumb and index finger of the other hand. Press and wiggle through the muscle tissue toward the edge of skin. Repeat as desired.  

Yin Tang Acupressure (Third Eye Point)

  • Benefits: Calms the mind and reduces anxiety.
  • Location: The point between your eyebrows.
  • Technique: Gently apply pressure with your index finger for 1-2 minutes, focusing on deep, slow breaths. 

Heart 7 Acupressure (Shenmen)

  • Benefits: Soothes the mind and alleviates anxiety.
  • Location: On the wrist crease, aligned with your little finger.
  • Technique: Apply firm, steady pressure with your thumb for 1-2 minutes. 

Pericardium 6 Acupressure (Neiguan)

  • Benefits: Reduces anxiety and nausea.
  • Location: On the inner forearm, about three finger-widths below the wrist crease, between the two tendons.
  • Technique: Apply gentle, circular pressure with your thumb for 1-2 minutes. 

Neck Relief for Headaches and Soreness

  • Benefits: Relieves headaches and neck tension.
  • Location: Base of the skull where it meets the spine.
  • Technique: Take the palm of your hand and center it at the back of the head. With medium pressure, squeeze and grasp the back of the neck by drawing the fingers toward the center. Release and repeat 4 times with the right hand, then 4 times with the left hand. 

Temple Massage for Tension Headaches and Tired Eyes:

  • Benefits: Alleviates tension headaches and eye strain.
  • Location: Temples, just beside the eyes.
  • Technique: Place your index and middle fingertips at the temple. With light pressure, make 6 to 8 clockwise circular movements, then 6 to 8 counterclockwise circular movements. Repeat as desired.

Essential Oils and Aromatherapy

The use of essential oils and aromatherapy can also help amplify some of these techniques.

Key Essential Oils & Benefits:

  • Lavender: Promotes relaxation, reduces anxiety  
  • Chamomile: Calms the nervous system, promotes relaxation  
  • Bergamot: Reduces anxiety, uplifts mood  
  • Ylang Ylang: Reduces anxiety, promotes relaxation  

Usage: Diffuse, inhale directly, or apply diluted to the skin 

Thank you to our content partners at Sharp HealthCare. 

Need Additional Well-Being Support?

While acupressure and self-massage techniques can be powerful tools for stress management, sometimes we need additional support. California Schools VEBA (CalVEBA) offers a range of resources to help you navigate life’s challenges and daily stress.

Optum Wellbeing Solutions (EWS)

  • 24/7 Support: For immediate assistance with stress, relationship conflicts, work-life balance, communication strategies, and more, contact Optum EWS.  
  • Dedicated Workplace Support Consultants: CalVEBA members and their dependents (18+) in California can access no-cost counseling visits virtually or in-person at the VEBA Resource Centers (Kearny Mesa and Carlsbad).  
    • Available: Monday – Friday, 10 am – 7 pm.
    • To Book: Visit https://bit.ly/optumvrc, create an account, enter the verification code, and select “Onsite service” to choose your appointment type (in-person, video, or telephone). 

Therapy Resources:

  • California Schools VEBA (CalVEBA) Therapy:
    • Short-term mental health support is available. Schedule a consultation with a CalVEBA Care Navigator—a critical care and holistic Registered Nurse. 
    • To schedule a Care Navigation appointment, call 619-398-4220 or book an appointment here. The Care Navigator will assist you with scheduling your therapy appointment and connect you with the resources you need for long-term support and care. 
  • Health Plan Network Therapists:
    • Kaiser Members: For mental health care, call Kaiser Permanente directly.  
      • Call: 833-579-4848 (8 am – 5:30 pm, Monday – Friday). 
    • UnitedHealthcare Members: Sign in to your member account or call the number on your member ID card. For more information regarding wellness resources visit.

Questions about your mental health benefits or need help finding an in-network provider? Contact the California Schools VEBA Advocacy Team for assistance with benefits eligibility, enrollment questions, or finding a therapist within your network.

Thank you to our content partners at Sharp HealthCare.

How to Quiet the Mind and Calm the Body 

In today’s fast-paced world, it can be easy to feel overwhelmed by constant distractions and a noisy mind. This mental clutter can lead to stress, anxiety, and even physical health issues.

Fortunately, mindfulness practices offer a powerful way to cultivate inner peace and improve overall well-being. The American Psychological Association highlights that mindfulness can significantly reduce stress, anxiety, and depression, aid in pain management and addiction recovery, and potentially boost the immune system.

Quiet Your Mind

Try these seven simple mindfulness practices to quiet your mind and calm your body:  

1. Stop To Rest

Notice what you see, hear, and feel in the moment you pause in stillness. Listen to this mindful moment meditation to soak in the beauty around you.

2. Relax with Your Breath

Take a deep breath and focus on your exhalation, feeling yourself letting go as you breathe out. Follow along with this 7-11 breathing practice.

3. Visual Awareness

Focus on something interesting or beautiful you see nearby and take a moment to notice its details. Follow along with this grounding meditation that engages your 5 senses.

4. Listen to Your Surroundings

Bring your attention to the sounds you hear and pause to listen carefully, focusing on each sound separately. Watch this guided meditation to tune into your surroundings and notice the sounds around you.

5. Check-In with Your Body

Bring your attention into your body and feel the sensations in each area. Release any tension or tightness and let relaxation spread. Watch this 10-minute guided chair yoga sequence to invigorate energy into the body.

6. Keep the Good Things in Mind

Imagine someone or something you love and feel the joy and serenity it brings to your life. Check out this journal prompt to help you reflect on moments of joy.

7. Focus on Gratitude

Think about someone or something you’re grateful for and reflect on how it enriches your life. Start your mornings with a virtual Gratitude Meditation class.

Calm Your Body

Incorporating these mindfulness practices into your daily routine can significantly enhance your ability to navigate life’s challenges with clarity and resilience. Embrace mindfulness and experience the transformative power of inner peace.

Thank you to our content partners at Sharp HealthCare.

California Schools VEBA (CalVEBA) Mindfulness Resources

Explore a variety of mindfulness classes, both virtual and in-person, by visiting our calendar. Access on-demand mindfulness and meditation videos anytime in our video library.

To watch more videos on mindfulness and ways to manage stress, check out our YouTube Channel.

New Health Plan: Here’s What to Do Next

Selecting a new health plan that is right for your health and budget is an important part of healthy living. Now that you’ve made your selection, there are things you need to do to ensure the transition to the new plan goes smoothly. These steps can prevent disruption to your care, limit out-of-pocket expenses, and help you ​maximize your​ benefits.

Revisit Your Benefits

Refreshing your understanding of what’s covered by your plan is a good idea throughout the year, especially at the start of a plan year. Your best source of information is your health plan’s Summary of Benefits and Coverage (SBC). It’s an easy-to-understand overview of benefits and coverage provided by a health plan. Health insurance companies are required to provide this document for all plan types. We know this document can be intimidating, so we put together a guide defining terms, sections, and key information. You can view the guide here. Familiarize yourself with your plan’s coverage and benefits for the most value and cost savings.

Additionally, you’ll want to check to see if there are any pre-existing condition rules. The Affordable Care Act (ACA) prevents insurers from denying coverage or charging more for pre-existing conditions. But there are exceptions. Grandfathered health plans — plans in place on or before March 23, 2010 — aren’t required to have the same ACA protections. Check to see if your new plan falls in this category and what that might mean for you.

Take Advantage of Online Resources

You don’t have to worry about bringing your plan materials on the go with you. CalVEBA members can access their plan information online through the MyVEBA Member Portal. Register and sign in to:

  • View Your current health plan.
  • Access digital ID cards for yourself or your dependents.
  • Review your Summary of Benefits and Coverage (SBC).
  • Access plan documents and benefit resources.

Transfer Medical Records

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), only you or your representative has a right to access your medical records. Providers and health plans can send your information to another provider or plan if it’s needed for care or payment — otherwise, you’ll need to permit them. If you’re changing PCPs, you’ll want to submit a Medical Records Transfer form or Medical Records Release form. Call your PCP’s office, and they can get one to you. 

Choosing the Right Primary Care Provider

Health happens beyond the doctor’s office, but meeting with your Primary Care Provider (PCP) can make all the difference in managing your overall well-being. Your PCP is your go-to resource for preventive care, specialist referrals, and personalized support, ensuring your care is consistent, coordinated, and aligned with your goals.

If your plan is a Health Maintenance Organization (HMO), your PCP will also help manage referrals, ensuring you only receive medically necessary care.

Here’s how to pick your PCP:

  • Contact The CalVEBA Advocacy Team at 888-276-0250 or through an online form. Be sure to have the following information ready:  
    • Name  
    • Date of Birth or Social Security Number  
    • Medical Group 
  • Use our new provider search tool, coming soon!

Is your new plan a Health Maintenance Organization (HMO)? HMOs typically require that you get referrals from your PCP to see specialists. That way, they can coordinate your care and make sure you’re getting what’s medically necessary.

Note: If you don’t select a PCP, one will automatically be assigned to you. You can change your PCP and medical group anytime during the year, but you cannot change your benefits plan.

Update Your Contact Information

Making sure your new plan has the right contact information for you is important. The goal is not to enable the insurance company to contact you unnecessarily. Rather, it’s to make sure that you receive plan information, claims are processed smoothly, and you get timely notifications.

Here When You Need Us

The Advocacy Team is here to help you navigate the healthcare system—whether it’s accessing care, dealing with referrals and prior authorizations, or making the most of your CalVEBA benefits for you and your family. 

If you have any questions, contact The Advocacy Team at 888-276-0250 or submit a contact form. For urgent requests, use the “Urgent” box on the contact form.

Health Happens Every Day 

Your wellness journey goes beyond routine doctor’s visits—good health is about daily choices to nourish and care for your body and mind. Whether you’re cooking a nutritious meal, practicing mindfulness, or getting active, every step counts toward building a balanced, healthy life. 

To help you on this journey, CalVEBA offers resources designed to support your daily health efforts. Explore tips and tools for maintaining a healthy lifestyle and staying on top of your wellness goals.  

Understanding Your Health Plan Coverage 

If you find health insurance confusing, rest assured, you are not alone. From uncommon terms to complex grids of benefits to cost share percentages, many people have trouble fully understanding their health plan coverage. In fact, one study shows that over half of the adults surveyed felt at least one part of their health insurance was difficult to understand. Let’s demystify your health plan by walking through where to find your benefits information and how to decode it. 

Summary of Benefits and Coverage

Your best source of information is your health plan’s Summary of Benefits and Coverage (SBC). It’s an easy-to-understand overview of benefits and coverage provided by a health plan. Health insurance companies are required to provide this document for all plan types so that prospective and current members know their benefits and are also able to compare plans more easily. With that said, there’s still a lot of to unpack in this document. Below you’ll find an explanation of each section. 

Plan Information

The SBC starts with general information about a plan. This includes the type of plan it is, dates the coverage is active, and who is covered. In addition, the introduction directs you to where you can find term definitions that will be used in the document.  

Important Questions

Following the general plan introduction is a section called Important Questions. It clarifies your share of costs for care like your deductible and out-of-pocket maximums. Additionally, this section explains the plan’s use of in-network and out-of-network providers and your access to each. 

Common Medical Events

Next is a grid of common medical scenarios, what you’ll pay for each, and any rules or limitations associated. You can use this section to really get into the nuts and bolts of a plan and determine if its coverage is right for your current health needs and budget.  

Exclusions

Some medical services are not covered by your plan such as cosmetic surgery, long-term care, coverage when you travel, and routine eye care. The SBC will outline what those are and what that means for you. Sometimes what’s not covered is just as important for you as what is so make sure to review this section, too. 

Coverage Examples

People learn differently. To ensure that everyone fully understands a plan, the SBC includes examples of coverage for specific medical conditions or events. One coverage and cost share example may be living with type 2 diabetes and another may be having a baby. 

Prescription Drug Coverage

If a plan includes prescription drug coverage, the SBC will direct you to a formulary or list of covered drugs and cost-sharing to review. Take the time to review that document even if you don’t have any prescriptions as that could change.  

Rights to Continued Coverage

This section lets you know that you have a right to continued coverage unless you move out of the coverage area, don’t pay your premiums, or fraud the insurer. A carrier cannot take away your coverage because of any health issues.  

Your Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: [insert State, HHS, DOL, and/or other applicable agency contact information]. Other coverage options may be available to you, too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318- 2596. 

Where and When to Review Your SBC

Now that you know the basics of a SBC, you can review it when you want to confirm your current coverage or compare coverage options. You can access your current plan’s SBC on MyVEBA. With Open Enrollment starting, you should be provided a new one soon. Under the Affordable Care Act, the SBC must be distributed with enrollment forms. If there is an auto-renew of a plan, employers must provide the SBC within 30 days of the plan beginning. Sometimes plans change coverage during the year. You’ll receive a new SBC with those changes at least 60 days in advance. So make sure to review any important plan inform 

Working Together for Your Healthiest Life

If you find this blog helpful in understanding health insurance and the open enrollment period, be sure to check out the other blogs in this series for more in-depth information here. 

Get Support: The VEBA Advocacy Team can help you review your health plan and discuss it with you in depth. Call 888-276-0250 or visit calveba.org/contact for assistance. For urgent requests, use the “Urgent” box on the contact form. 

MyVEBA Portal: Easily view your current health plan information through the online portal.

Benefit Contacts: For assistance with specific carrier benefits or issues, such as claims or coverage details, visit calveba.org/benefit-contacts to contact them directly.    

What is Open Enrollment?

In the United States, most people sign up for health care plans during the annual Open Enrollment. Navigating health care plans can be confusing, so it’s important to be well-informed about your options – whether or not you intend to switch your plan. 

Open Enrollment is a critical window that can affect you, and your family’s health care options for years to come. Looking at health care plans can bring up questions, especially before Open Enrollment. Going in prepared helps to ensure that you make the best choice for you and your family. 

Here’s a comprehensive list of questions and answers to help you easily navigate Open Enrollment.  

What exactly is Open Enrollment?

Open Enrollment is when individuals and families in the U.S. can sign up for insurance plans each year. During this period, you can look at and purchase a plan typically through the Health Insurance Marketplace or your employer.  

When is the Open Enrollment period? 

The Open Enrollment period can vary slightly depending on your employer. Your employer’s Open Enrollment dates are unique. Please contact your Benefits Administrator for more information on your enrollment period to ensure you sign up for coverage within your window. 

Pro Tip: Mark these dates on your calendar so you don’t miss this critical window. 

What changes can I make during Open Enrollment?

Open Enrollment is the time to evaluate your current and future health care needs and make any necessary changes. During this period, you can choose a new insurance company and plan to find one that best suits your changing health care needs. 

You can also renew your health insurance, as well as add or remove dependents or spouses, and adjust your adult vision and dental coverage.  

Do I always need to review my options?

It can be tempting to just stick with the plan you already have. It’s important to review your options each year, even if your budget or health care needs haven’t changed. 

This is because many factors can affect the price and service offered by your insurance provider that are out of your control. Other factors that may impact your health care plan include states changing the prices of certain premiums or having new insurers enter the marketplace.  

Reviewing your options is an important part of being proactive about your health and well-being. 

Who needs to enroll during Open Enrollment?

Every person who is not a dependent should take part in Open Enrollment. That includes whether or not you want to make changes to your existing plan. Open Enrollment applies to you whether you’re purchasing insurance through the marketplace, Medicare, or your employer. 

What terms do I need to know before Open Enrollment?

There are a lot of confusing terms in the world of health care. Here are some of the top ones you should know before Open Enrollment: 

  • Deductible: How much you must spend for covered health services before your insurance company pays anything (except free preventive services). 
  • Copay: A fixed amount of money that an individual is required to pay out-of-pocket for a specific health care service or medication, typically at the time of service.  
  • Coinsurance: A cost-sharing arrangement in health care where the insured individual is responsible for paying a percentage of the covered medical expenses, typically after meeting their deductible.  
  • Premium: Premium refers to the amount of money an individual or entity pays to an insurance company in exchange for insurance coverage. This is usually paid monthly or annually. 
  • Out-of-pocket maximum: The maximum amount an individual is required to pay for covered health care services during a specific period, usually a calendar year.  

What happens if I miss the Open Enrollment period?

If you miss the Open Enrollment, your plan typically automatically renews for the next year. If your current plan is no longer available, you may be enrolled in a similar plan instead. If you don’t currently have a health care plan, you may miss your opportunity to enroll unless you meet certain requirements. 

The restrictions around Open Enrollment can vary depending on the state, income level, and whether you are eligible for Medicare. Native Americans can enroll in a health plan at any time, without needing a qualifying event. 

How do I compare the costs of different plans?

One of the most important factors to consider when choosing a plan is the cost compared to the benefits received. People often just look at the monthly premium, however, there’s much more that goes into the cost of your insurance. 

Besides the premium, some other costs to consider are your deductible, copayments and coinsurance, out-of-pocket maximum, and your estimated health care needs for the year. 

Will I receive new ID cards this year? 

As technology evolves so will your health insurance! No, you will not be receiving your new insurance ID cards in the mail like you typically do. In 2025, all carrier ID cards will be digital.  

You receive more information about your new digital ID cards during Open Enrollment. If you’d prefer a physical ID card, you can still request one from your plan carrier.

How should I prepare for Open Enrollment?

It’s almost Open Enrollment, and being prepared will make this process that much easier. Here a few more things to keep in mind as you prepare for Open Enrollment: 

  • Know how much health care you may need next year, including wiggle room for emergencies or the unexpected. 
  • See if your preferred providers and hospitals are within the network of the plans you’re looking at. 
  • Are you or your family expecting any changing medical needs in the next year such as pregnancy or surgery? 

Once you have a good idea of your budget and health care needs, ask your employee benefits contact for more information on where and when to enroll. With all this information at your fingertips, you’ll be able to easily pick out the best plan for you and your family. 

If you find this blog helpful in understanding health insurance and the open enrollment period, be sure to check out the other blogs in this series for more in-depth information here. 

VEBA Resources  

MyVEBA Portal: Easily view your current health plan information through the .   

Benefit Contacts: For assistance with specific carrier benefits or issues, such as claims or coverage details, visit calveba.org/benefit-contacts to contact them directly.    

Get Support: The VEBA Advocacy Team can help you review your health plan and discuss it with you in depth. Call 888-276-0250 or visit calveba.org/contact for assistance. For urgent requests, use the “Urgent” box on the contact form.