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A Guide to Your Health and Wellness Benefits | 2020
Glossary
Glossary
Brand Name Drugs: Drugs that have trade names and are Outpatient: Services provided to an individual at a hospital
protected by patents. Brand name drugs are generally the facility without an overnight hospital stay.
most costly choice.
Out-of-Pocket Maximum: The maximum amount you and
Coinsurance: The percentage of a covered charge paid by your family must pay for eligible expenses each plan year.
the plan. Once your expenses reach the out-of-pocket maximum, the
plan pays benefits at 100% of eligible expenses for the
Copayment (Copay): A flat dollar amount you pay for remainder of the year under all medical plans.
medical or prescription drug services regardless of the
actual amount charged by your doctor or health care Prescription Drug Tiers
provider. Generic Most generic drugs and low cost preferred
brands
Deductible: The annual amount you and your family must Brand Non-preferred generic drugs or;
pay each year before the plan pays benefits. Preferred brand name drugs or;
Medications recommended by the plan’s
Generic Drugs: Generic drugs are less expensive versions pharmaceutical and therapeutics (P&T)
of brand name drugs that have the same intended use, committee based on drug safety, efficacy and
dosage, effects, risks, safety and strength. The strength cost.
and purity of generic medications are strictly regulated by Non-Brand Non-preferred brand name drugs or;
the Federal Food and Drug Administration. Medications recommended by P&T committee
based on drug safety, efficacy and cost or;
In-Network: Use of a health care provider that participates Generally have a preferred and often less
in the plan’s network. When you use providers in the costly therapeutic alternative at a lower tier.
network, you lower your out-of-pocket expenses because Specialty Food and Drug Administration (FDA) or
the plan pays a higher percentage of covered expenses. Drug manufacturer limits distribution to
specialty pharmacy or;
Out-of-Network: Use of a health care provider that does Self-administration requires training, clinically
not participate in a plan’s network. monitoring or;
Drug was manufactured using biotechnology
Mail Order Pharmacy: Mail order pharmacies generally
provide a 90-day supply of a prescription medication for Primary Care Physician (PCP): Physician (generally a family
the same cost as a 60-day supply at a retail pharmacy. Plus, practitioner, internist or pediatrician) who provides ongoing
mail order pharmacies offer the convenience of shipping medical care. A primary care physician treats a wide variety
directly to your door. of health-related conditions and refers patients to
specialists as necessary.
Inpatient: Services provided to an individual during an
overnight hospital stay. Specialist: A physician who has specialized training in a
particular branch of medicine (e.g., a surgeon,
Brand Name Drugs: Drugs that have trade names and are gastroenterologist or neurologist).
protected by patents. Brand name drugs are generally the
most costly choice. Outpatient: Services provided to an individual at a hospital
facility without an overnight hospital stay.
Coinsurance: The percentage of a covered charge paid by
the plan. Out-of-Pocket Maximum: The maximum amount you and
your family must pay for eligible expenses each plan year.
Once your expenses reach the out-of-pocket maximum, the
Copayment (Copay): A flat dollar amount you pay for plan pays benefits at 100% of eligible expenses for the
medical or prescription drug services regardless of the remainder of the year under all medical plans.
actual amount charged by your doctor or health care 11 | 2020 Benefit Guide
provider.
Prescription Drug Tiers
Tier 1 – Most generic drugs and low cost preferred
Deductible: The annual amount you and your family must brands
pay each year before the plan pays benefits. Tier 2 - Non-preferred generic drugs or;
Preferred brand name drugs or;
