Page 20 - Immucor Benefit Guide

Glossary

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

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