Page 22 - Guaranty Home Mortgage-2022-Benefit Guide

Important Terms to Know

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

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