Page 26 - 2018 SLU Enrollment
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Glossary
This glossary deines some of the terms Medically Necessary Care—medical
commonly used throughout this guide to care required to identify and treat
describe your beneits. an illness or injury. All care must be
considered medically necessary by the
Annual Deductible—the amount of Plan Administrator for beneits to be
covered medical or dental expenses you paid.
pay out-of-pocket each year before the
plan pays beneits. Network—a group of independent
doctors, hospitals, and other healthcare
Annual Out-of-Pocket Maximum— providers who contract with a plan to
the most you must pay for eligible provide care at predetermined rates.
medical expenses in a year. Once To participate in the network, providers
expenses reach the out-of-pocket must adhere to the plan carrier’s quality
maximum, the plan pays 100% of guidelines.
eligible expenses for the rest of the year.
Outpatient mental health and substance Precertiication—a procedure by
abuse services continue to be paid at which your medical plan is notiied and
speciied plan levels. pre-approves hospitalization and certain
other medical services.
Coinsurance—the percentage you pay
out-of-pocket for covered services under Primary Care Physician (PCP)—a
the healthcare plans. network doctor of your choice who
coordinates your medical care under
Copayment—the ixed amount you the medical plan. A PCP is usually a
pay up front for most in-network general practitioner, family practitioner,
services (such as ofice visits) under the internist, or pediatrician. Your PCP
healthcare plans. may be responsible for referring you
Emergency Condition—a serious to specialists, as well as pre-certifying
accident or sudden illness with severe hospitalization.
symptoms which occurs unexpectedly. Urgent Care—medically necessary
An emergency condition is one which treatment of severe symptoms which
could be life-threatening or cause occur unexpectedly but are not life-
serious bodily harm if not treated threatening. Urgent care is appropriate
immediately (for example, severe when delaying treatment could lead
bleeding or loss of consciousness). to serious medical problems and when
Health Savings Account—is a tax- treatment is received in an urgent care
advantaged medical savings account center rather than in an emergency
available to employees enrolled in the room.
HSA medical plan. The funds contributed
to an HSA are not subject to federal
income tax at the time of deposit
and can be used tax-free for eligible
expenses.
26 2018 Benefits Enrollment
This glossary deines some of the terms Medically Necessary Care—medical
commonly used throughout this guide to care required to identify and treat
describe your beneits. an illness or injury. All care must be
considered medically necessary by the
Annual Deductible—the amount of Plan Administrator for beneits to be
covered medical or dental expenses you paid.
pay out-of-pocket each year before the
plan pays beneits. Network—a group of independent
doctors, hospitals, and other healthcare
Annual Out-of-Pocket Maximum— providers who contract with a plan to
the most you must pay for eligible provide care at predetermined rates.
medical expenses in a year. Once To participate in the network, providers
expenses reach the out-of-pocket must adhere to the plan carrier’s quality
maximum, the plan pays 100% of guidelines.
eligible expenses for the rest of the year.
Outpatient mental health and substance Precertiication—a procedure by
abuse services continue to be paid at which your medical plan is notiied and
speciied plan levels. pre-approves hospitalization and certain
other medical services.
Coinsurance—the percentage you pay
out-of-pocket for covered services under Primary Care Physician (PCP)—a
the healthcare plans. network doctor of your choice who
coordinates your medical care under
Copayment—the ixed amount you the medical plan. A PCP is usually a
pay up front for most in-network general practitioner, family practitioner,
services (such as ofice visits) under the internist, or pediatrician. Your PCP
healthcare plans. may be responsible for referring you
Emergency Condition—a serious to specialists, as well as pre-certifying
accident or sudden illness with severe hospitalization.
symptoms which occurs unexpectedly. Urgent Care—medically necessary
An emergency condition is one which treatment of severe symptoms which
could be life-threatening or cause occur unexpectedly but are not life-
serious bodily harm if not treated threatening. Urgent care is appropriate
immediately (for example, severe when delaying treatment could lead
bleeding or loss of consciousness). to serious medical problems and when
Health Savings Account—is a tax- treatment is received in an urgent care
advantaged medical savings account center rather than in an emergency
available to employees enrolled in the room.
HSA medical plan. The funds contributed
to an HSA are not subject to federal
income tax at the time of deposit
and can be used tax-free for eligible
expenses.
26 2018 Benefits Enrollment
