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be withdrawn at any time to cover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