Page 18 - Mitsubishi-2022-Benefit Guide-MCCFC-MCA Golf-V14(JO)-LRI

Glossary

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

● In-network – A designated list of health care handling, administration or monitoring. Most can only
providers (doctors, dentists, etc.) with whom the be filled by a specialty pharmacy and have additional
health insurance provider has negotiated special required approvals.
rates. Using in-network providers lowers the cost of
services for you and the company.

18