Page 26 - 2022 DPR Construction Benefit Guide_Craft Employees

Glossary of Terms

Aggregate Deductible Copay

Typically found on high-deductible plans; when enrolled A fixed amount (for example $15) you pay for a covered
in family coverage, the health plan does not begin paying health care service, usually when you receive the service.
benefits until the entire family deductible has been met. The amount can vary by the type of covered health care
service.
Benefit
Deductible
The amount of money (or other types of compensation,
such as wellness credits) you receive from an insurance The amount you have to pay for covered health care
carrier. services before your health plan begins to pay.

Brand Name Drugs Dependent

Drugs that have trade names and are protected by patents. A qualifying child or spouse/domestic partner who relies on
Brand name drugs are generally the most costly choice. you for financial support.

Calendar Year Maximum A child includes a natural child, a stepchild, a legally
adopted child, a child placed for adoption, a child for
A calendar year maximum is the total amount paid each whom legal guardianship has been awarded, or a child
year by your insurance company for each family member for whom health care coverage is required through a
enrolled in the medical plan. ‘Qualified Medical Child Support Order’ or other court or
administrative order. Please refer to your plan summaries
Coinsurance
for age restrictions.
The sharing of cost between you and the plan. For example,
80 percent coinsurance means the plan covers 80 percent Explanation of Benefits
of the cost of service after a deductible is met, and you will A statement sent by your insurance carrier that explains
be responsible for the remaining 20 percent of the cost. which procedures and services were provided, how much
they cost, what portion of the claim was paid by the plan,
and what portion is your liability, in addition to how you can
appeal the insurer’s decision. These statements are also
posted on the carrier’s website for your review.

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