Page 6 - 2019 Benefit Guide Non-CA

MEDICAL GLOSSARY

As you review your medical options, it is important to understand the costs associated with each plan. Your
individual situation will determine which of these costs has the most influence on your plan selection.

Employee Contributions:
The Employee Contribution is the amount you pay through payroll deductions for the plans you choose. The
Employee Contribution amount depends on which plans you choose and whether you are covering
dependents. Employee contributions are deducted from your paycheck on a pre-tax basis. Premiums for non-
IRS tax dependents will be deducted on a post-tax basis.

Deductible:
A deductible is the amount you must pay before the medical insurance begins to pay any benefits, unless the
deductible is waived.

Copay:
A copay is a set amount you pay for a specific service, such as an office visit or a prescription.

Coinsurance:
Some plans require that you pay a percentage of the cost of a service. This percentage is coinsurance.

Out-of-Pocket Maximum:
This is a very important fact to understand. This annual maximum limit protects you from unlimited medical
expenses. The maximum is the most you will have to pay for eligible expenses during the plan year. Once you
meet the out-of-pocket maximum the plan will pay 100% of all eligible expenses.

Your Costs:
Out-of-Pocket costs along with your Employee Contributions comprise your total health care costs.

Annual Out-of-Pocket Maximums

In-Network
Out-of-Network
PLAN In-Network Only (Single / Family) (Single / Family)
(Single / Family)
HMO (OAP IN) $4,500 / $9,000 N/A N/A
PPO (OAP) N/A $4,500 / $9,000 $9,000 / $18,000
HSA N/A $5,000 / $10,000 $10,000 / $20,000

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