Page 27 - 2015 Four Seasons Sante Fe/Vail Enrollment Guide
P. 27
2015 Open Enrollment
Glossary
This glossary deines some of the terms commonly used throughout this
guide to describe your beneits.
Annual Deductible—the amount of covered medical or dental expenses Maximum Reimbursable
you pay out-of- pocket each year before the plan pays beneits. Charge—the lesser of: 1.
The provider’s normal charge for a
Annual Out-of-Pocket Maximum—the most you must pay for eligible similar service or supply; or 2. The
medical expenses in a year. Once expenses reach the out-of-pocket policyholder-selected percentile
maximum, the plan pays 100% of covered, medically necessary R&C of all charges made by providers
expenses for the rest of the year. Outpatient mental health and substance of such service or supply in the
abuse services continue to be paid at speciied plan levels. geographic area where it is received.
To determine if a charge exceeds
Coinsurance—the percentage you pay out-of-pocket for covered services the maximum reimbursable charge,
under the health care plans. the nature and severity of the injury
Copayment—the ixed amount you pay up front for most in-network or sickness may be considered.
services (such as ofice visits) under the health care plans. Medically Necessary Care—
medical care required in order
Domestic Partner—a person of the same or opposite sex with whom you
have a long-term relationship and live (for the six-month period immediately to identify and treat an illness or
prior to enrolling for beneits), and who is over age 18, unmarried, mentally injury. All care must be considered
competent, unrelated to you, and your only domestic partner. (Special rules medically necessary by the Plan
apply to same-sex spouses.) Administrator for beneits to be
paid.
Emergency Condition—a serious accident or sudden illness with severe
symptoms which occurs unexpectedly. An emergency condition is one Network—a group of independent
which could be life threatening or cause serious bodily harm if not treated doctors, hospitals, and other
immediately (for example, severe bleeding or loss of consciousness). health care providers who contract
with a plan to provide care at
Health Savings Account—is a tax-advantaged medical savings account predetermined rates. To participate
available to employees enrolled in the HSA medical plan. The funds in the network, providers must
contributed to an HSA are not subject to federal income tax at the time of adhere to the plan carrier’s quality
deposit and can be used tax-free for eligible expenses. guidelines.
Precertiication—a procedure by
which your Medical Plan is notiied
and pre-approves hospitalization
and certain other medical services.
27
Glossary
This glossary deines some of the terms commonly used throughout this
guide to describe your beneits.
Annual Deductible—the amount of covered medical or dental expenses Maximum Reimbursable
you pay out-of- pocket each year before the plan pays beneits. Charge—the lesser of: 1.
The provider’s normal charge for a
Annual Out-of-Pocket Maximum—the most you must pay for eligible similar service or supply; or 2. The
medical expenses in a year. Once expenses reach the out-of-pocket policyholder-selected percentile
maximum, the plan pays 100% of covered, medically necessary R&C of all charges made by providers
expenses for the rest of the year. Outpatient mental health and substance of such service or supply in the
abuse services continue to be paid at speciied plan levels. geographic area where it is received.
To determine if a charge exceeds
Coinsurance—the percentage you pay out-of-pocket for covered services the maximum reimbursable charge,
under the health care plans. the nature and severity of the injury
Copayment—the ixed amount you pay up front for most in-network or sickness may be considered.
services (such as ofice visits) under the health care plans. Medically Necessary Care—
medical care required in order
Domestic Partner—a person of the same or opposite sex with whom you
have a long-term relationship and live (for the six-month period immediately to identify and treat an illness or
prior to enrolling for beneits), and who is over age 18, unmarried, mentally injury. All care must be considered
competent, unrelated to you, and your only domestic partner. (Special rules medically necessary by the Plan
apply to same-sex spouses.) Administrator for beneits to be
paid.
Emergency Condition—a serious accident or sudden illness with severe
symptoms which occurs unexpectedly. An emergency condition is one Network—a group of independent
which could be life threatening or cause serious bodily harm if not treated doctors, hospitals, and other
immediately (for example, severe bleeding or loss of consciousness). health care providers who contract
with a plan to provide care at
Health Savings Account—is a tax-advantaged medical savings account predetermined rates. To participate
available to employees enrolled in the HSA medical plan. The funds in the network, providers must
contributed to an HSA are not subject to federal income tax at the time of adhere to the plan carrier’s quality
deposit and can be used tax-free for eligible expenses. guidelines.
Precertiication—a procedure by
which your Medical Plan is notiied
and pre-approves hospitalization
and certain other medical services.
27
