Page 20 - Cytokinetics 2022 Benefits Guide

Glossary

• Brand Preferred drugs – A drug with a patent and • In-network – A designated list of health care providers
trademark name that is considered “preferred” because it (doctors, dentists, etc.) with whom the insurance provider
is appropriate to use for medical purposes and is usually has negotiated special rates. Using an in-network
less expensive than other brand-name options. contracted providers lowers the cost of services for you
• Brand Non-Preferred drugs – A drug with a patent and and the company.
trademark name. This type of drug is “not preferred” and is • Inpatient – Services provided to an individual during an
usually more expensive than alternative generic and brand overnight hospital stay.
preferred drugs. • Mail Order Pharmacy – Mail order pharmacies
• Calendar Year Maximum – The maximum benefit generally provide a 90-day supply of a prescription
amount paid each year for each family member enrolled medication for the same cost as a 60-day supply at a
in the dental plan or any other plan that has set annual retail pharmacy. Plus, mail order pharmacies offer the
maximum levels. convenience of shipping directly to your door.
• Coinsurance – The sharing of cost between you and • Out-of-network – Health care providers who are not
the plan. For example, 80% coinsurance means the plan in the plan’s network and who have not negotiated
covers 80% of the cost of service after a deductible is discounted rates. The cost of services provided by
met. You will be responsible for the remaining 20% of out-of-network providers is much higher for you and the
the cost. company. Additional deductibles and higher coinsurance
• Copay – A fixed amount (for example $15) you pay for will apply.
a covered health care service, usually when you receive • Out-of-pocket maximum – The maximum amount you
the service. The amount can vary by the type of covered and your family must pay for eligible expenses each
health care service. plan year. Once your expenses reach the out-of-pocket
• Deductible – The amount you have to pay for covered maximum, the plan pays benefits at 100% of eligible
services each year before your health plan begins to pay. expenses for the remainder of the year. Your annual
• Elimination Period – The time period between the deductible is included in your out-of-pocket maximum.
beginning of an injury or illness and receiving benefit • Outpatient – Services provided to an individual at a
payments from the insurer. hospital facility without an overnight hospital stay.
• Flexible Spending Accounts (FSA) – FSAs allow • Primary Care Provider (PCP) – A doctor (generally a
you to pay for eligible health care and dependent care family practitioner, internist or pediatrician) who provides
expenses using tax-free dollars. The money in the ongoing medical care. A primary care physician treats a
account is subject to the “use it or lose it” rule which wide variety of health-related conditions.
means you must spend the money in the account • Reasonable & Customary Charges (R&C) –
before the end of the plan year. Prevailing market rates for services provided by health
• Generic drugs – A drug that offers equivalent uses, doses, care professionals within a certain area for certain
strength, quality and performance as a brand-name drug procedures. Reasonable and Customary rates may
but is not trademarked. apply to out-of-network charges. Your plan will only pay
• Health Savings Account (HSA) – An HSA is a personal up to the reasonable and customary charges. You are
savings account for those enrolled in a High Deductible responsible to pay the amounts in excess of this charge.
Health Plan (HDHP). You may use your HSA to pay for • Specialist – A provider who has specialized training
qualified medical expenses such as doctor’s office visits, in a particular branch of medicine (e.g., a surgeon,
hospital care, prescription drugs, dental care and vision cardiologist or neurologist).
care. You can use the money in your HSA to pay for • Specialty drugs – A drug that requires special
qualified medical expenses now, or in the future, for your handling, administration or monitoring. Most can only
expenses and those of your spouse/domestic partner and be filled by a specialty pharmacy and have additional
dependents, even if they are not covered by the HDHP. required approvals.
• High Deductible Health Plan (HDHP) – A qualified
High Deductible Health Plan (HDHP) is defined by the
Internal Revenue Service (IRS) as a plan with a minimum
annual deductible and a maximum out-of-pocket limit.
These minimums and maximums are determined
annually and are subject to change.

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