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Glossary

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

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