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GLOSSARY

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

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