Page 41 - GLG 2021 Annual Benefits
P. 41
Beneits Terminology
A handy reference for the insurance terms used in this guide.
Deductible A deductible is the set amount you must pay for medical or dental expenses (aside from copays that may
apply) before insurance begins to cover all or a portion of your costs. Deductibles reset January 1 each year.
Copay A copay (or copayment) is a set, lat fee that you pay for medical services or prescriptions in addition to
what the insurance company covers.
Coinsurance Once the deductible is met, coinsurance is the percentage you pay of each service until you reach your out-
of-pocket maximum.
Out-of-Pocket Maximum An out-of-pocket maximum is a limit to the amount of money that you must pay before your expenses are
covered at 100% for in-network only services.
In-Network In-Network providers or healthcare facilities are part of a health plan’s network, and you usually pay less for
using these providers.
Out-of-Network Out-of-Network providers are not part of the health plan provider network. Expenses for services are not
discounted through the insurance carrier, and are covered at a lesser amount by GLG’s plan. In addition, the
provider can bill you for any amount not covered by your plan.
Flexible Spending Account An FSA allows you to set aside a portion of your pre-tax earnings to pay for eligible medical, dental, vision,
(FSA) or daycare expenses. Money deducted from your pay into an FSA is not subject to payroll taxes, resulting in
a substantial payroll tax savings.
Limited Purpose Flexible A Limited Purpose Flexible Spending Account (LFSA) is a lexible spending account option for employees
Spending Account (LFSA) enrolled in a Health Savings Account (HSA) Program with a High Deductible Health Plan (HDHP), or whose
legal partner is enrolled in a HDHP with an HSA. The LFSA is limited to eligible dental and vision expenses
only.
Health Savings Account A Health Savings Account (HSA) is a tax-advantaged medical savings account you can contribute to and
(HSA) draw money from for certain medical expenses tax-free. HSAs can be used for out-of-pocket medical,
dental, and vision expenses.
Prior Authorization Prior authorization, sometimes called pre-approval, is notiication required by the insurance company
before obtaining certain medical services. To obtain prior authorization for a service, just call the insurance
company. If you do not obtain prior authorization before your appointment, the insurance company can deny
your claim and the service will not be covered.
Premium The premium is the amount that must be paid for your health insurance per paycheck.
Claim A claim is a request to the insurance company to pay for your healthcare services. For in-network services,
your provider submits a claim on your behalf. For out-of-network services, you must pay the provider up
front and submit a claim to the insurance company for reimbursement.
Explanation of Beneits Provides information about how your claim was processed by the carrier. The EOB outlines what portion of
(EOB) the claim was paid by the plan and what portion is your responsibility.
Preventive Care Preventive Care is routine healthcare that includes screenings, check-ups, and patient counseling to prevent
illnesses, disease, or other health problems. Preventive care and immunizations will be covered without any
cost sharing (covered at 100%). Some examples of preventive care are well-baby/well-child, well-person
exams, mammograms, prostate cancer screenings, and various immunizations (including the lu vaccine).
Annual Maximum Beneit The Annual Maximum Beneit is the maximum dollar amount a dental plan will pay toward the cost
of dental care within a speciic beneit period (January through December). The patient is personally
responsible for paying costs above the annual maximum.
Evidence of Insurability Evidence of Insurability (EOI) is an application process in which you provide information on the condition of
(EOI) your health or your dependent’s health in order to be considered for additional life insurance.
41
A handy reference for the insurance terms used in this guide.
Deductible A deductible is the set amount you must pay for medical or dental expenses (aside from copays that may
apply) before insurance begins to cover all or a portion of your costs. Deductibles reset January 1 each year.
Copay A copay (or copayment) is a set, lat fee that you pay for medical services or prescriptions in addition to
what the insurance company covers.
Coinsurance Once the deductible is met, coinsurance is the percentage you pay of each service until you reach your out-
of-pocket maximum.
Out-of-Pocket Maximum An out-of-pocket maximum is a limit to the amount of money that you must pay before your expenses are
covered at 100% for in-network only services.
In-Network In-Network providers or healthcare facilities are part of a health plan’s network, and you usually pay less for
using these providers.
Out-of-Network Out-of-Network providers are not part of the health plan provider network. Expenses for services are not
discounted through the insurance carrier, and are covered at a lesser amount by GLG’s plan. In addition, the
provider can bill you for any amount not covered by your plan.
Flexible Spending Account An FSA allows you to set aside a portion of your pre-tax earnings to pay for eligible medical, dental, vision,
(FSA) or daycare expenses. Money deducted from your pay into an FSA is not subject to payroll taxes, resulting in
a substantial payroll tax savings.
Limited Purpose Flexible A Limited Purpose Flexible Spending Account (LFSA) is a lexible spending account option for employees
Spending Account (LFSA) enrolled in a Health Savings Account (HSA) Program with a High Deductible Health Plan (HDHP), or whose
legal partner is enrolled in a HDHP with an HSA. The LFSA is limited to eligible dental and vision expenses
only.
Health Savings Account A Health Savings Account (HSA) is a tax-advantaged medical savings account you can contribute to and
(HSA) draw money from for certain medical expenses tax-free. HSAs can be used for out-of-pocket medical,
dental, and vision expenses.
Prior Authorization Prior authorization, sometimes called pre-approval, is notiication required by the insurance company
before obtaining certain medical services. To obtain prior authorization for a service, just call the insurance
company. If you do not obtain prior authorization before your appointment, the insurance company can deny
your claim and the service will not be covered.
Premium The premium is the amount that must be paid for your health insurance per paycheck.
Claim A claim is a request to the insurance company to pay for your healthcare services. For in-network services,
your provider submits a claim on your behalf. For out-of-network services, you must pay the provider up
front and submit a claim to the insurance company for reimbursement.
Explanation of Beneits Provides information about how your claim was processed by the carrier. The EOB outlines what portion of
(EOB) the claim was paid by the plan and what portion is your responsibility.
Preventive Care Preventive Care is routine healthcare that includes screenings, check-ups, and patient counseling to prevent
illnesses, disease, or other health problems. Preventive care and immunizations will be covered without any
cost sharing (covered at 100%). Some examples of preventive care are well-baby/well-child, well-person
exams, mammograms, prostate cancer screenings, and various immunizations (including the lu vaccine).
Annual Maximum Beneit The Annual Maximum Beneit is the maximum dollar amount a dental plan will pay toward the cost
of dental care within a speciic beneit period (January through December). The patient is personally
responsible for paying costs above the annual maximum.
Evidence of Insurability Evidence of Insurability (EOI) is an application process in which you provide information on the condition of
(EOI) your health or your dependent’s health in order to be considered for additional life insurance.
41
