Page 49 - 2022 Insurity OE Guide FINAL

In-Network: Use of a health care provider that participates in the Qualifying Life Event (QLE): A qualifying event is an event
plan’s network. that triggers an Open Enrollment window for an individual or
family to purchase or change insurance, outside the scheduled
Inpatient: Services provided to an individual during an overnight
Open Enrollment period. Examples of qualifying events include
hospital stay.
marriage, divorce or legal separation, birth, adoption of a child,
Mail Order Pharmacy: A pharmacy which delivers drugs to
loss of other coverage, etc.
patients through the mail, directly to their homes. Insurity plans
allow a 90-day supply through mail order at only 2 ½ times the Specialist: A physician who specializes in a particular branch of
applicable copay. medicine (e.g., a surgeon, gastroenterologist or neurologist).
TeleHealth: A virtual visit with your own in-network provider. The
Open Enrollment: Period of time, occurring once per year,
cost will be the same as if you were visiting your own provider
which allows employees to review and make changes to their
in-office.
current benefit elections. During this period individuals may
add or delete benefits, switch to alternate plan options and Virtual Visit: Virtual care option with one of the three approved
add or delete eligible dependents. Outside of the annual Open in-network virtual visit providers (Teladoc, Doctor on Demand or
Enrollment period, changes cannot be made without a Qualifying Amwell). This is NOT a visit with your own provider.
Life Event.

Out-of-Network: Use of a doctor or health care provider that
does not participate in a plan’s network.

Out-of-Pocket Maximum – In-Network: This is the maximum
amount you will pay for your portion of health care claim costs
during the plan year. Once you have paid the out-of-pocket
maximum, the plan will cover your eligible medical expenses at
100% for the balance of the plan year.
Outpatient: Services provided to an individual at a hospital
facility without an overnight hospital stay.
Preventive Visits: These visits, regardless of which plan you
choose, are covered by your insurance plan at no cost to you.
See pages 23–25 for lists of recommended preventive care
services.

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