Page 15 - 2022 OCFJSD Benefits Guide
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Glossary of
Medical Plan Terms
Brand Name Drugs—Drugs that have trade names and are
protected by patents. Brand name drugs are generally the
costliest choice.
Coinsurance—The percentage of a covered charge paid by
the plan.
Copayment (Copay)—A flat dollar amount you pay for Inpatient—Services provided to an individual
medical or prescription drug services regardless of the actual during an overnight hospital stay.
amount charged by your doctor or health care provider.
Outpatient—Services provided to an individual at
Deductible—The annual amount you and your family must a hospital facility without an overnight hospital
pay each year before the plan pays benefits. stay.
Generic Drugs—Generic drugs are less expensive versions of Out-of-Pocket Maximum—The maximum amount
brand name drugs that have the same intended use, dosage, you and your family must pay for eligible expenses
effects, risks, safety and strength. The strength and purity of each plan year. Once your expenses reach the out-
generic medications are strictly regulated by the Federal Food of-pocket maximum, the plan pays benefits at
and Drug Administration. 100% of eligible expenses for the remainder of the
year, except for prescriptions under all medical
In-Network—Use of a health care provider that participates in plans except the HSA Plan.
the plan’s network. When you use providers in the network,
you lower your out-of-pocket expenses because the plan pays Primary Care Physician (PCP)—physician
a higher percentage of covered expenses. (generally a family practitioner, internist or
pediatrician) who provides ongoing medical care. A
Out-of-Network—Use of a health care provider that does not primary care physician treats a wide variety of
participate in a plan’s network. health-related conditions.
Mail Order Pharmacy—Mail order pharmacies generally Specialist—A physician who has specialized
provide a 90-day supply of a prescription medication for the training in a particular branch of medicine (e.g., a
same cost as a 60-day supply at a retail pharmacy. Plus, mail surgeon, gastroenterologist or neurologist).
order pharmacies offer the convenience of shipping directly
to your door.
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