Page 23 - Benefit Guide
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Glossary
΅΅ Brand preferred drugs – A drug with a patent and ΅΅ High Deductible Health Plan (HDHP) – A qualified High
trademark name that is considered “preferred” because it Deductible Health Plan (HDHP) is defined by the Internal
is appropriate to use for medical purposes and is usually Revenue Service (IRS) as a plan with a minimum annual
less expensive than other brand-name options. deductible and a maximum out-of-pocket limit. These
minimums and maximums are determined annually and
΅΅ Brand non-preferred drugs – A drug with a patent and are subject to change.
trademark name. This type of drug is “not preferred” and is
usually more expensive than alternative generic and brand ΅΅ In-network – A designated list of health care providers
preferred drugs. (doctors, dentists, etc.) with whom the health insurance
provider has negotiated special rates. Using in-network
΅΅ Calendar Year Maximum – The maximum benefit providers lowers the cost of services for you and the
amount paid each year for each family member enrolled company.
in the dental plan.
΅΅ Inpatient – Services provided to an individual during an
΅΅ Coinsurance – The sharing of cost between you and overnight hospital stay.
the plan. For example, 80 percent coinsurance means
the plan covers 80 percent of the cost of service after ΅΅ Mail Order Pharmacy – Mail order pharmacies generally
a deductible is met. You will be responsible for the provide a 90-day supply of a prescription medication for
remaining 20 percent of the cost. the same cost as a 60-day supply at a retail pharmacy.
Plus, mail order pharmacies offer the convenience of
΅΅ Copay – A fixed amount (for example $15) you pay for a shipping directly to your door.
covered health care service, usually when you receive
the service. The amount can vary by the type of covered ΅΅ Out-of-network – Health care providers that are not
health care service. in the plan’s network and who have not negotiated
discounted rates. The cost of services provided by
΅΅ Deductible – The amount you have to pay for covered out-of-network providers is much higher for you and
services before your health plan begins to pay. the company. Additional deductibles and higher
coinsurance will apply.
΅΅ Elimination Period – The time period between the
beginning of an injury or illness and receiving benefit ΅΅ Out-of-pocket maximum – The maximum amount you
payments from the insurer. and your family must pay for eligible expenses each
plan year. Once your expenses reach the out-of-pocket
΅΅ Flexible Spending Accounts (FSA) – FSAs allow you maximum, the plan pays benefits at 100% of eligible
to pay for eligible health care and dependent care expenses for the remainder of the year. Your annual
expenses using tax-free dollars. The money in the deductible is included in your out-of-pocket maximum.
account is subject to the “use it or lose it”
rule which means you must spend the money in the ΅΅ Outpatient – Services provided to an individual at a
account before the end of the plan year. hospital facility without an overnight hospital stay.
΅΅ Generic drugs – A drug that offers equivalent uses, doses, ΅΅ Primary Care Provider (PCP) – A doctor (generally
strength, quality and performance as a brand-name drug, a family practitioner, internist or pediatrician) who
but is not trademarked. provides ongoing medical care. A primary care physician
treats a wide variety of health-related conditions.
΅΅ Health Savings Account (HSA) – An HSA is a personal
health care account for those enrolled in a High ΅΅ Reasonable & Customary Charges (R&C) – Prevailing
Deductible Health Plan (HDHP). You may use your HSA market rates for services provided by health care
to pay for qualified medical expenses such as doctor’s professionals within a certain area for certain
office visits, hospital care, prescription drugs, dental procedures. Reasonable and Customary rates may
care, and vision care. You can use the money in your apply to out-of-network charges.
HSA to pay for qualified medical expenses now, or in
the future, for your expenses and those of your spouse/ ΅΅ Specialist – A provider who has specialized training
domestic partner and dependents, even if they are not in a particular branch of medicine (e.g., a surgeon,
covered by the HDHP. cardiologist or neurologist).
΅΅ Health Reimbursement Arrangement (HRA) – A fund ΅΅ Specialty drugs – A drug that requires special handling,
you can use to help pay for eligible medical costs not administration or monitoring. Most can only be filled
covered by your medical plan. Funds are contributed to by a specialty pharmacy and have additional required
the HRA by the company. approvals.
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