Page 17 - AFL 2022 Grandfathered Guide with Legal Notices

GLOSSARY

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

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