Page 20 - TimkenSteel 2022 Benefit Guide

GLOSSARY

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

20