Page 21 - 2022 US Benefits Guide FINAL
P. 21
GLOSSARY
Brand preferred drugs – A drug Health Savings Account (HSA) – Out-of-network – Health care
with a patent and trademark name An HSA is a personal health care providers that are not in the plan’s
that is considered “preferred” account for those enrolled in a High network and who have not
because it is appropriate to use for Deductible Health Plan (HDHP). You negotiated discounted rates. The
medical purposes and is usually less may use your HSA to pay for cost of services provided by out-of-
expensive than other brand-name qualified medical expenses such as network providers is much higher for
options. doctor’s office visits, hospital care, you and the company. Additional
Brand non-preferred drugs – A prescription drugs, dental care, and deductibles and higher coinsurance
will apply.
drug with a patent and trademark vision care. You can use the money
name. This type of drug is “not in your HSA to pay for qualified Out-of-pocket maximum – The
preferred” and is usually more medical expenses now, or in the maximum amount you and your
expensive than alternative generic future, for your expenses and those family must pay for eligible expenses
and brand preferred drugs. of your spouse/domestic partner and each plan year. Once your expenses
dependents, even if they are not reach the out-of-pocket maximum,
Calendar Year Maximum – The covered by the HDHP. the plan pays benefits at 100% of
maximum benefit amount paid each eligible expenses for the remainder
year for each family member enrolled High Deductible Health Plan of the year. Your annual deductible
in the dental plan. (HDHP) – A qualified High
Deductible Health Plan (HDHP) is is included in your out-of-pocket
Coinsurance – The sharing of cost defined by the Internal Revenue maximum.
between you and the plan. For Service (IRS) as a plan with a Outpatient – Services provided to
example, 80 percent coinsurance minimum annual deductible an individual at a hospital facility
means the plan covers 80 percent of and a maximum out-of-pocket limit. without an overnight hospital stay.
the cost of service after a deductible These minimums and maximums are
is met. You will be responsible for determined annually and are subject Primary Care Provider (PCP) – A
the remaining 20 percent of the cost. to change. doctor (generally a family
Copay – A fixed amount (for In-network – A designated list of practitioner, internist or pediatrician)
who provides ongoing medical care.
example $25) you pay for a covered health care providers (doctors, A primary care physician treats a
health care service, usually when dentists, etc.) with whom the health wide variety of health-related
you receive the service. The amount insurance provider has negotiated conditions.
can vary by the type of covered special rates. Using in-network
health care service. providers lowers the cost of services Reasonable & Customary Charges
Deductible – The amount you have for you and the company. (R&C) – Prevailing market rates for
services provided by health care
to pay for covered services before Inpatient – Services provided to an professionals within a certain area
your health plan begins to pay. individual during an overnight for certain procedures. Reasonable
Elimination Period – The time hospital stay. & Customary rates may apply to
period between the beginning of an Mail Order Pharmacy – Mail order out-of-network charges.
injury or illness and receiving benefit pharmacies generally provide a 90- Specialist – A provider who has
payments from the insurer. day supply of a prescription specialized training in a particular
Flexible Spending Account (FSA) medication for the same cost as a branch of medicine (e.g., a surgeon,
– An FSA allows you to pay for 60-day supply at a retail pharmacy. cardiologist or neurologist).
eligible health care and dependent Plus, mail order pharmacies offer the Specialty drugs – A drug that
care expenses using tax-free dollars. convenience of shipping directly to requires special handling,
The money in the account is subject your door. administration or monitoring. Most
to the “use it or lose it” rule which can only be filled by a specialty
means you must spend the money in pharmacy and have additional
the account before the end of the required approvals.
plan year.
Generic drugs – A drug that offers
equivalent uses, doses, strength,
quality and performance as a brand-
name drug, but is not trademarked.
21
