Page 28 - Zenoss, Inc 2022 Flipbook

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
amount paid each year for each family member enrolled for the same cost as 2.5 times your 30-day retail copay
in the dental plan. amount at a retail pharmacy as long as you are staying
• Coinsurance – The sharing of cost between you and in network. Plus, mail order pharmacies offer the
the plan. For example, 80 percent coinsurance means convenience of shipping directly to your door.
the plan covers 80 percent of the cost of service after • Out-of-network – Health care providers that are not
a deductible is met. You will be responsible for the in the plan’s network and who have not negotiated
remaining 20 percent of the cost. discounted rates. The cost of services provided by
• Copay – A fixed amount (for example $15) you pay for a out-of-network providers is much higher for you and
covered health care service, usually when you receive the company. Additional deductibles and higher
the service. The amount can vary by the type of covered coinsurance will apply.
health care service. • Out-of-pocket maximum – The maximum amount you
• Deductible – The amount you have to pay for covered and your family must pay for eligible expenses each
services before your health plan begins to pay. plan year. Once your expenses reach the out-of-pocket
• Elimination Period – The time period between the maximum, the plan pays benefits at 100% of eligible
beginning of an injury or illness and receiving benefit expenses for the remainder of the year. Your annual
payments from the insurer. deductible is included in your out-of-pocket maximum.
• Flexible Spending Accounts (FSA) – FSAs allow you • Outpatient – Services provided to an individual at a
to pay for eligible health care and dependent care hospital facility without an overnight hospital stay.
expenses using tax-free dollars. The money in the • Primary Care Provider (PCP) – A doctor (generally
account is subject to the “use it or lose it” rule which a family practitioner, internist or pediatrician) who
means you must spend the money in the account before provides ongoing medical care. A primary care physician
the end of the plan year. treats a wide variety of health-related conditions.
• Generic drugs – A drug that offers equivalent uses, doses, • Reasonable & Customary Charges (R&C) – Prevailing
strength, quality and performance as a brand-name drug, market rates for services provided by health care
but is not trademarked. professionals within a certain area for certain
• Health Savings Account (HSA) – An HSA is a personal procedures. Reasonable and Customary rates may
health care account for those enrolled in a High apply to out-of-network charges.
Deductible Health Plan (HDHP). You may use your HSA • Specialist – A provider who has specialized training
to pay for qualified medical expenses such as doctor’s in a particular branch of medicine (e.g., a surgeon,
office visits, hospital care, prescription drugs, dental cardiologist or neurologist).
care, and vision care. You can use the money in your • Specialty drugs – A drug that requires special
HSA to pay for qualified medical expenses now, or in the handling, administration or monitoring. Most can only
future, for your expenses and those of your spouse and be filled by a specialty pharmacy and have additional
dependents, even if they are not covered by the HDHP. required approvals.
• 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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