RALEIGH -- Recent news coverage of contractual disputes between health insurance companies and health care providers has led to consumers being confused about what their plan covers, says Insurance Commissioner Jim Long and staff at the Department of Insurance's Consumer Services Division. "Consumers are worried about what to do in the event of an emergency, or if their healthcare provider is no longer in the health plan's network.," Long said. "What if they go to a hospital or other provider that is not contracted with the health insurance plan?"

What do you need to know about your health insurance plan?

Know the differences in health insurance plans.

There are different kinds of health insurance plans. Many people have a comprehensive health insurance plan that they receive as a benefit from their employer or that they purchase themselves. Comprehensive plans typically cover a wide range of services including physician office visits, checkups, hospital procedures, emergency room visits, and more. Other health insurance plans may cover a more specific set of services or conditions, such as cancer policies or dental/vision care policies.

Know what your plan covers.

The most important thing a consumer can do is read his or her policy carefully. If you have any questions about what kind of services your plan covers, talk to your benefits coordinator or a representative of your health insurance company.

Know that state law gives you important protections in the event of an emergency.

Even if your health insurance plan does not contract with a specific hospital, emergency room services that meet the "prudent layperson" standard (as defined in North Carolina law), must be covered at that hospital's emergency room. The "prudent layperson" standard is met if visiting an emergency room is a reasonable thing to do, in light of the consumer's medical symptoms and history. A health insurance plan has the right to determine whether the standard was met, by reviewing medical records and other information - but not based on the network status of the hospital.

Remember, not all health plans include emergency services as a covered benefit, and some types of health plans are not subject to North Carolina insurance laws, so check with your benefits coordinator to get more information about your own health plan. Even if your plan is not regulated by the Department of Insurance, you may still have similar protections under other state or federal laws. No matter what your insurance situation, your health is the most important thing. Don't delay seeking help during an emergency.

Know that if you have a special ongoing health condition, and your provider becomes out-of-network, you may be entitled to continue to use your current providers for a period of time.

In cases where your employer changes to a different health plan, or the contract between the health plan and your provider is terminated, you may be able to continue to use your "out-of-network" doctors and hospitals. Special health conditions such as acute illness, chronic disease, pregnancy or a terminal illness are eligible for this continued coverage. Again, this only applies to certain plans subject to North Carolina law, so contact your benefits coordinator, health plan, or the Department of Insurance for clarification.

Know that the Department of Insurance is here to help you sort through your health insurance questions.

You can call us at 1-800-546-5664 or visit the NCDOI Web site.