Page 6 - 2016 Nortek Enrollment Guide Kaiser
P. 6
6
Glossary
Premium: The amount you contribute
each month from your paycheck for
insurance coverage. UHC Account-based Plans
Deductible: A set dollar amount Let’s take a look at the key features of each plan.
you have to pay for your healthcare
expenses before the company starts Health Reimbursement Health Savings Account
Arrangement
to share costs with you. Deductibles Out-of- Out-of-
vary by plan and by coverage levels. In-Network Network In-Network Network
Coinsurance: Once you’ve satisied Calendar Year Deductible
the deductible, this is a set percentage Individual $1,750 $3,500 $3,000 $6,000
of the remaining costs which are your Family $3,500 $7,000 $6,000 $12,000
60%
Coinsurance
80%
60%
80%
responsibility, until you reach your out- Out-of-Pocket
of-pocket max. Maximum Includes Deductible Includes Deductible
Copay: A set dollar amount you pay Individual $3,500 $7,000 $6,000 $12,000
$14,000
$24,000
for services every time you use them. Family $7,000 Not available $12,000 Not available
100%
100%
Preventive care
Out of pocket max: Generally, the Ofice Visit Copay
most you can spend on healthcare for Primary care $30 copay Ded/60% Ded/80% Ded/60%
the year, not including your monthly physician
premiums. Specialist $60 copay Ded/60% Ded/80% Ded/60%
HRA: A Health Reimbursement Emergency room $200 copay; $200 copay; Ded/80% Ded/80%
Ded/80%
Ded/80%
Arrangement includes an account Urgent Care $60 copay Ded/60% Ded/80% Ded/60%
that the company establishes for Virtual Visits $20 copay N/A Ded/80% N/A
you. HRAs do not accept employee Prescription Drugs
contributions. Pharmacy Out-of-Pocket Maximum
HSA: A Health Savings Account is Individual $3,100 N/A Pharmacy expenses are
a personal bank account you own included in your medical out
and is used to pay for qualiied Family $6,200 N/A of pocket maximum
medical expenses. Whatever money Retail
you contribute or accumulate is Tier 1 $10 copay $10 copay Ded/80% Ded/60%
$30 copay
Ded/80%
Ded/60%
$30 copay
Tier 2
yours for life. Employees can make Tier 3 $60 copay $60 copay Ded/80% Ded/60%
contributions to the account up to Tier 4 $90 copay $90 copay Ded/80% Ded/60%
the allowed maximum contribution Mail Order
limits. The IRS contribution limits for Tier 1 $20 copay Ded/80%
2016 are $3,350 for individuals and Tier 2 $60 copay Ded/80%
$6,750 for families. These funds can Tier 3 $120 copay Not available Ded/80% Not available
be withdrawn at any time to cover Tier 4 Not available Not available
qualiied medical expenses as deined
by the IRS. Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Nortek
Glossary
Premium: The amount you contribute
each month from your paycheck for
insurance coverage. UHC Account-based Plans
Deductible: A set dollar amount Let’s take a look at the key features of each plan.
you have to pay for your healthcare
expenses before the company starts Health Reimbursement Health Savings Account
Arrangement
to share costs with you. Deductibles Out-of- Out-of-
vary by plan and by coverage levels. In-Network Network In-Network Network
Coinsurance: Once you’ve satisied Calendar Year Deductible
the deductible, this is a set percentage Individual $1,750 $3,500 $3,000 $6,000
of the remaining costs which are your Family $3,500 $7,000 $6,000 $12,000
60%
Coinsurance
80%
60%
80%
responsibility, until you reach your out- Out-of-Pocket
of-pocket max. Maximum Includes Deductible Includes Deductible
Copay: A set dollar amount you pay Individual $3,500 $7,000 $6,000 $12,000
$14,000
$24,000
for services every time you use them. Family $7,000 Not available $12,000 Not available
100%
100%
Preventive care
Out of pocket max: Generally, the Ofice Visit Copay
most you can spend on healthcare for Primary care $30 copay Ded/60% Ded/80% Ded/60%
the year, not including your monthly physician
premiums. Specialist $60 copay Ded/60% Ded/80% Ded/60%
HRA: A Health Reimbursement Emergency room $200 copay; $200 copay; Ded/80% Ded/80%
Ded/80%
Ded/80%
Arrangement includes an account Urgent Care $60 copay Ded/60% Ded/80% Ded/60%
that the company establishes for Virtual Visits $20 copay N/A Ded/80% N/A
you. HRAs do not accept employee Prescription Drugs
contributions. Pharmacy Out-of-Pocket Maximum
HSA: A Health Savings Account is Individual $3,100 N/A Pharmacy expenses are
a personal bank account you own included in your medical out
and is used to pay for qualiied Family $6,200 N/A of pocket maximum
medical expenses. Whatever money Retail
you contribute or accumulate is Tier 1 $10 copay $10 copay Ded/80% Ded/60%
$30 copay
Ded/80%
Ded/60%
$30 copay
Tier 2
yours for life. Employees can make Tier 3 $60 copay $60 copay Ded/80% Ded/60%
contributions to the account up to Tier 4 $90 copay $90 copay Ded/80% Ded/60%
the allowed maximum contribution Mail Order
limits. The IRS contribution limits for Tier 1 $20 copay Ded/80%
2016 are $3,350 for individuals and Tier 2 $60 copay Ded/80%
$6,750 for families. These funds can Tier 3 $120 copay Not available Ded/80% Not available
be withdrawn at any time to cover Tier 4 Not available Not available
qualiied medical expenses as deined
by the IRS. Please refer to your Summary Plan Description (SPD) for complete details of plan beneits,
limitations, and exclusions. In the event of a conlict between the SPD and this description, the
terms of the SPD will prevail.
Nortek
