Page 19 - Mitsubishi-2022-Benefit Guide-V13(JO)-LRI

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