Page 4 - Benefit Guide
P. 4
2019 Benefits Enrollment
MEDICAL AND PRESCRIPTION
In-Network vs.
Out-of-Network DRUG
A network is a group of providers [Client Name] offers a robust medical insurance program to our
your plan contracts with at
discounted rates. You will almost employees. We partner with [Carrier] to offer this coverage.
always pay less when you receive
care in-network.
Plan Highlights
If you choose to see an out-of- You have the option of choosing one of [X] plans. Our plans offer
network provider, you may be
balance billed, which means you coverage for most healthcare services. When you receive care in-network
will be responsible for charges you beneit from our negotiated discounts with [Carrier].
above [Carrier]’s reimbursement
amount.
[Carrier] Member Site
The [Carrier] member site, www.[Carrier].com offers many valuable
services including the following.
Important z In-network providers and pharmacy searches
Insurance Terms z Prescription drug formulary
z Deductible: the amount of
money you are responsible z Access to temporary ID cards and means to order another ID card
for paying up-front before Information regarding paid and pending claims
your plan shares your costs z
z Coinsurance: the
percentage you and the plan Employee Medical Contributions
pay; in our plans, you pay a [Plan 1] [Plan 2]
smaller percentage and the
plan pays a larger percentage Employee Only $ $
z Copay: a ixed amount for Employee and Spouse $ $
certain services you pay in Employee and Child(ren) $ $
some of our plans Family $ $
z Out-of-pocket maximum:
the limit on your expenses;
once you reach this limit,
the plan covers all eligible
expenses for the remainder
of the plan year
4
MEDICAL AND PRESCRIPTION
In-Network vs.
Out-of-Network DRUG
A network is a group of providers [Client Name] offers a robust medical insurance program to our
your plan contracts with at
discounted rates. You will almost employees. We partner with [Carrier] to offer this coverage.
always pay less when you receive
care in-network.
Plan Highlights
If you choose to see an out-of- You have the option of choosing one of [X] plans. Our plans offer
network provider, you may be
balance billed, which means you coverage for most healthcare services. When you receive care in-network
will be responsible for charges you beneit from our negotiated discounts with [Carrier].
above [Carrier]’s reimbursement
amount.
[Carrier] Member Site
The [Carrier] member site, www.[Carrier].com offers many valuable
services including the following.
Important z In-network providers and pharmacy searches
Insurance Terms z Prescription drug formulary
z Deductible: the amount of
money you are responsible z Access to temporary ID cards and means to order another ID card
for paying up-front before Information regarding paid and pending claims
your plan shares your costs z
z Coinsurance: the
percentage you and the plan Employee Medical Contributions
pay; in our plans, you pay a [Plan 1] [Plan 2]
smaller percentage and the
plan pays a larger percentage Employee Only $ $
z Copay: a ixed amount for Employee and Spouse $ $
certain services you pay in Employee and Child(ren) $ $
some of our plans Family $ $
z Out-of-pocket maximum:
the limit on your expenses;
once you reach this limit,
the plan covers all eligible
expenses for the remainder
of the plan year
4
