Page 22 - Interior Architects-2022-23-Benefit Guide

Glossary

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

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