Page 23 - Ampact 2022 Benefit Guide

Glossary of Medical Plan Terms

Coinsurance—The percentage of a covered charge paid by Flexible Spending Account (FSA) – An FSA allows you to pay for
the plan. eligible health care and dependent care expenses using tax-free

dollars. The money in the account is subject to the “use it or lose
Copayment (Copay)—A flat dollar amount you pay for it” rule which means you must spend the money in the account
medical or prescription drug services regardless of the actual before the end of the plan year.
amount charged by your doctor or health care provider.
High Deductible Health Plan (HDHP)—A medical plan that may
Deductible—The annual amount you and your family must be used in conjunction with a health savings account (HSA).
pay each year before the plan pays benefits.
Health Savings Account (HSA)—A fund you can use to help pay
• Embedded Deductible – once the individual for eligible medical costs not covered by your medical plan. Both
deductible has been met, coverage begins whether employers and employees may contribute to this fund;
or not the family deductible has been met. employees do so through pre-tax payroll deductions.
• Non-Embedded Deductible – an aggregate Imputed Income- the value of the domestic partner coverage
deductible where the total family deductible must be minus the after-tax amount contributed toward the coverage.
met before coverage begins. This amount will also be subject to income tax withholding and
Domestic Partner (defined for our insurance purposes)- Same employment taxes.
or opposite sex adults who are not legally married, share a In-Network—Use of a health care provider that participates in the
residence, who are in a long-term committed relationship of plan’s network. When you use providers in the network, you lower
mutual caring and responsibility for each other’s common your out-of-pocket expenses because the plan pays a higher
welfare and intend to continue the relationship indefinitely. percentage of covered expenses.
• Each other’s sole domestic partner for at least the Inpatient—Services provided to an individual during an overnight
previous 12 months hospital stay.

• At least 19 years of age. Outpatient—Services provided to an individual at a hospital
• Legally capable to enter into a contract; and facility without an overnight hospital stay.
• Not related by blood closer than permitted by Out-of-Network—Use of a health care provider that does not
marriage law in your state of residence. participate in a plan’s network.
Drugs Out-of-pocket maximum – The maximum amount you and your
family must pay for eligible expenses each plan year. Once your
• Brand Name Drugs—Drugs that have trade names expenses reach the out-of-pocket maximum, the plan pays
and are protected by patents. Brand name drugs benefits at 100% of eligible expenses for the remainder of the
are generally the more expensive choice. year. Your annual deductible is included in your out-of-pocket
• Generic Drugs—Generic drugs are less expensive maximum.
versions of brand name drugs that have the same Mail Order Pharmacy—Mail order pharmacies generally provide
intended use, dosage, effects, risks, safety and a 90-day supply of a prescription medication for the same cost as
strength. The strength and purity of generic a 60-day supply at a retail pharmacy. Plus, mail order pharmacies
medications are strictly regulated by the Federal offer the convenience of shipping directly to your door.
Food and Drug Administration.
• Formulary Drugs – health insurance providers provide
a list of medications approved by a team of
physicians and pharmacists that will be covered
under the insurance benefits.

• Non-Formulary Drugs – Drugs that are not included
on the list of preferred medications. They are
typically a brand-name medication that has no
available generic equivalent.

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Effective August 1, 2022-July 31, 2023