Page 22 - Draken Intl. 2022 OE Flipbook

Glossary

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

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