Page 19 - Tessenderlo Kerley, Inc 2022 Benefit Guide

GLOSSARY
Brand Preferred Drugs – A drug with
a patent and trademark name that
is considered “preferred” because
it is appropriate to use for medical
purposes and is usually less expensive
than other brand-name options.
Brand Non-Preferred Drugs – A drug
with a patent and trademark name.
This type of drug is “not preferred”
and is usually more expensive
than alternative generic and brand
preferred drugs.
Calendar Year Maximum –
The maximum benefit amount paid
each year for each family member
enrolled in the dental plan.
Coinsurance – The sharing of
cost between you and the plan.
For example, 80% coinsurance means
the plan covers 80% of the cost of
service after a deductible is met.
You will be responsible for the
remaining 20% of the cost.
Copay – A fixed amount (for example
$15) you pay for a covered health care
service, usually when you receive the
service. The amount can vary by the
type of covered health care service.
WELCOME BENEFIT BASICS MEDICAL
Deductible – The amount you have Inpatient – Services provided to Outpatient – Services provided to an
to pay for covered services each year an individual during an overnight individual at a hospital facility without
before your health plan begins to pay. hospital stay. an overnight hospital stay.
Elimination Period – The time period Mail Order Pharmacy – Mail order Primary Care Provider (PCP) –
between the beginning of an injury pharmacies generally provide a A doctor (generally a family
or illness and receiving benefit 90-day supply of a prescription practitioner, internist or pediatrician)
payments from the insurer. medication for the same cost as a who provides ongoing medical care.
Flexible Spending Account (FSA) – 60-day supply at a retail pharmacy. A primary care physician treats a wide
An FSA allows you to pay for eligible Plus, mail order pharmacies offer the variety of health-related conditions.
health care and dependent care convenience of shipping directly to Reasonable & Customary Charges
expenses using tax-free dollars. your door. (R&C) – Prevailing market rates for
The money in the account is subject Out-Of-Network (OON) – Providers services provided by health care
to the “use it or lose it” rule which that are not in the plan’s network and professionals within a certain area
means you must spend the money who have not negotiated discounted for certain procedures. Reasonable
in the account before the end of the rates. The cost of services provided & Customary rates may apply to
plan year. by out-of-network providers is much out-of-network charges.
Generic Drugs – A drug that offers higher for you and the company. Specialist – A provider who has
equivalent uses, doses, strength, quality Higher deductibles and coinsurance specialized training in a particular
and performance as a brand-name will apply. branch of medicine (e.g., a surgeon,
drug, but is not trademarked. Out-Of-Pocket (OOP) Maximum – cardiologist or neurologist).
In-Network (INN) – A designated The maximum amount you and
list of health care providers (doctors, your family must pay for eligible
dentists, etc.) with whom the expenses each plan year. Once your
insurance provider has negotiated expenses reach the out-of-pocket
special rates. Using in-network maximum, the plan pays benefits at
providers lowers the cost of services 100% of eligible expenses for the
for you and the company. remainder of the year. Your annual
deductible is included in your
out-of-pocket maximum.
DENTAL VISION FSA ADDITIONAL BENEFITS 401(k) CONTACTS LEGAL RIGHTS 19