Page 15 - 2024 HCTec Benefits Guide

Glossary

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

particular branch of medicine (e.g., a surgeon, cardiologist
or neurologist).
 Specialty drugs – A drug that requires special handling,
administration or monitoring. Most can only be filled
by a specialty pharmacy and have additional required
15 approvals.