Page 14 - McKenzie 2022 Benefit Guide SD Salary

GLOSSARY

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

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