Page 34 - 2022 DPR Construction Benefit Guide_Administrative Employees

Mail Order Pharmacy Premium

Mail order pharmacies generally provide a 90-day supply The specified amount of money you’ll pay monthly (usually
of a prescription medication for the same cost as a 60-day deducted from your salary each pay period) in exchange for
supply at a retail pharmacy. Plus, mail order pharmacies insurance coverage.
offer the convenience of shipping directly to your door.
Reasonable and Customary Rates (R&C)
Network Provider
Out-of-network health plan expenses are considered for
A provider who has a contract with your health insurer or reimbursement at reasonable and customary rates. R&C
plan to provide services at set fees. rates are determined to be the prevailing charge made for
a service by a similar provider in the same geographic area.
These contracted fees are usually lower than the provider’s Charges above R&C are not covered by the plan and are the
normal fees for services. responsibility of the participant.

Open Enrollment Specialist

A period of time (usually a few days to a few weeks) in which A physician who has specialized training in a particular
companies allow employees to choose their insurance branch of medicine (e.g., a surgeon, gastroenterologist
coverage for the coming year. or neurologist).
Out-of-Network Benefits Voluntary Benefits

The benefits applicable for the covered services of a Benefits (sometimes called “specialty,” “supplemental,” or
non-network provider. “ancillary”) that can be included in a benefits portfolio to

Out-of-Pocket Maximum achieve the best protection based on an employee’s needs.
These may include Critical Illness, Accident or Hospital
The highest amount you’ll pay toward medical expenses in Indemnity insurance, among others.
a year including deductibles, copays, and coinsurance, but
not monthly premiums. If the out-of-pocket-maximum is
met, any further qualified expenses will be 100% covered by
the insurance company for the remainder of the year.

Primary Care Physician (PCP)

Physician (generally a family practitioner, internist or
pediatrician) who provides ongoing medical care.
A primary care physician treats a wide variety of
health-related conditions.

Preferred Provider Organization (PPO)

A network of health care providers contracted to provide
medical services to covered employees and dependents at
negotiated rates. You may seek care from either a network
or non-network provider, but network care is covered at a
higher benefit level and the employee is responsible for
a greater portion of the cost when using a non-network
provider.

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