Page 28 - 2018 SLU New Hire Guide
P. 28
Glossary
This glossary deines some of the terms
commonly used throughout this guide to
describe your beneits.
Annual Deductible—the amount of Medically Necessary Care—medical
covered medical or dental expenses you care required to identify and treat
pay out-of-pocket each year before the an illness or injury. All care must be
plan pays beneits. considered medically necessary by the
Plan Administrator for beneits to be
Annual Out-of-Pocket Maximum— paid.
the most you must pay for eligible
medical expenses in a year. Once Network—a group of independent
expenses reach the out-of-pocket doctors, hospitals, and other healthcare
maximum, the plan pays 100% of providers who contract with a plan to
eligible expenses for the rest of the year. provide care at predetermined rates.
Outpatient mental health and substance To participate in the network, providers
abuse services continue to be paid at must adhere to the plan carrier’s quality
speciied plan levels. guidelines.
Coinsurance—the percentage you pay Precertiication—a procedure by
out-of-pocket for covered services under which your medical plan is notiied and
the healthcare plans. pre-approves hospitalization and certain
other medical services.
Copayment—the ixed amount you
pay up front for most in-network Primary Care Physician (PCP)—a
services (such as ofice visits) under the network doctor of your choice who
healthcare plans. coordinates your medical care under
the medical plan. A PCP is usually a
Emergency Condition—a serious general practitioner, family practitioner,
accident or sudden illness with severe internist, or pediatrician. Your PCP
symptoms which occurs unexpectedly. may be responsible for referring you
An emergency condition is one which to specialists, as well as pre-certifying
could be life-threatening or cause hospitalization.
serious bodily harm if not treated
immediately (for example, severe Urgent Care—medically necessary
bleeding or loss of consciousness). treatment of severe symptoms which
occur unexpectedly but are not life-
Health Savings Account—is a tax- threatening. Urgent care is appropriate
advantaged medical savings account when delaying treatment could lead
available to employees enrolled in the to serious medical problems and when
HSA medical plan. The funds contributed treatment is received in an urgent care
to an HSA are not subject to federal center rather than in an emergency
income tax at the time of deposit room.
and can be used tax-free for eligible
expenses.
28 2018 New Hire Guide
This glossary deines some of the terms
commonly used throughout this guide to
describe your beneits.
Annual Deductible—the amount of Medically Necessary Care—medical
covered medical or dental expenses you care required to identify and treat
pay out-of-pocket each year before the an illness or injury. All care must be
plan pays beneits. considered medically necessary by the
Plan Administrator for beneits to be
Annual Out-of-Pocket Maximum— paid.
the most you must pay for eligible
medical expenses in a year. Once Network—a group of independent
expenses reach the out-of-pocket doctors, hospitals, and other healthcare
maximum, the plan pays 100% of providers who contract with a plan to
eligible expenses for the rest of the year. provide care at predetermined rates.
Outpatient mental health and substance To participate in the network, providers
abuse services continue to be paid at must adhere to the plan carrier’s quality
speciied plan levels. guidelines.
Coinsurance—the percentage you pay Precertiication—a procedure by
out-of-pocket for covered services under which your medical plan is notiied and
the healthcare plans. pre-approves hospitalization and certain
other medical services.
Copayment—the ixed amount you
pay up front for most in-network Primary Care Physician (PCP)—a
services (such as ofice visits) under the network doctor of your choice who
healthcare plans. coordinates your medical care under
the medical plan. A PCP is usually a
Emergency Condition—a serious general practitioner, family practitioner,
accident or sudden illness with severe internist, or pediatrician. Your PCP
symptoms which occurs unexpectedly. may be responsible for referring you
An emergency condition is one which to specialists, as well as pre-certifying
could be life-threatening or cause hospitalization.
serious bodily harm if not treated
immediately (for example, severe Urgent Care—medically necessary
bleeding or loss of consciousness). treatment of severe symptoms which
occur unexpectedly but are not life-
Health Savings Account—is a tax- threatening. Urgent care is appropriate
advantaged medical savings account when delaying treatment could lead
available to employees enrolled in the to serious medical problems and when
HSA medical plan. The funds contributed treatment is received in an urgent care
to an HSA are not subject to federal center rather than in an emergency
income tax at the time of deposit room.
and can be used tax-free for eligible
expenses.
28 2018 New Hire Guide
