Page 23 - 2022 Drive Open Enrollment Guide - Non Union

Glossary

● Brand preferred drugs – A drug with a patent and ● High Deductible Health Plan (HDHP) – A qualified High
trademark name that is considered “preferred” because it Deductible Health Plan (HDHP) is defined by the Internal
is appropriate to use for medical purposes and is usually Revenue Service (IRS) as a plan with a minimum annual
less expensive than other brand-nameoptions. deductible and a maximum out-of-pocket limit. These
● Brand non-preferred drugs – A drug with a patent and minimums and maximums are determined annually and
trademark name. This type of drug is “not preferred” and is are subject to change.
usually more expensive than alternative generic andbrand ● In-network – A designated list of health care providers
preferred drugs. (doctors, dentists, etc.) with whom the health insurance
● Calendar Year Maximum – The maximum benefit provider has negotiated special rates. Using in-network
amount paid each year for each family member enrolled providers lowers the cost of services for you and the
in the dental plan. company.
● Coinsurance – The sharing of cost between you and ● Inpatient – Services provided to an individual during an
the plan. For example, 80 percent coinsurance means overnight hospital stay.
the plan covers 80 percent of the cost of service after ● Mail Order Pharmacy – Mail order pharmacies generally
a deductible is met. You will be responsible for the provide a 90-day supply of a prescription medication for
remaining 20 percent of the cost. the same cost as a 60-day supply at a retail pharmacy.
● Copay – A fixed amount (for example $15) you pay for a Plus, mail order pharmacies offer the convenience of
covered health care service, usually when you receive shipping directly to your door.
the service. The amount can vary by the type of covered ● Out-of-network – Health care providers that are not
health care service. in the plan’s network and who have not negotiated
● Deductible – The amount you have to pay for covered discounted rates. The cost of services provided by
services before your health plan begins to pay. out-of-network providers is much higher for you and
● Elimination Period – The time period between the the company. Additional deductibles and higher
coinsurance will apply.
beginning of an injury or illness and receiving benefit
payments from the insurer. ● Out-of-pocket maximum – The maximum amount you
and your family must pay for eligible expenses each
● Flexible Spending Accounts (FSA) – FSAs allow you
to pay for eligible health care and dependent care plan year. Once your expenses reach the out-of-pocket
maximum, the plan pays benefits at 100% of eligible
expenses using tax-free dollars. The money in the
expenses for the remainder of the year. Your annual
account is subject to the “use it or lose it” rule which
deductible is included in your out-of-pocket maximum.
means you must spend the money in the account
before the end of the plan year. ● Outpatient – Services provided to an individual at a
● Generic drugs – A drug that offers equivalent uses, doses, hospital facility without an overnight hospital stay.
strength, quality and performance as a brand-name drug, ● Primary Care Provider (PCP) – A doctor (generally
but is not trademarked. a family practitioner, internist or pediatrician) who
provides ongoing medical care. A primary care physician
● Health Savings Account (HSA) – An HSA is a personal
health care account for those enrolled in a High treats a wide variety of health-related conditions.
Deductible Health Plan (HDHP). You may use your HSA ● Reasonable & Customary Charges (R&C) – Prevailing
to pay for qualified medical expenses such as doctor’s market rates for services provided by health care
office visits, hospital care, prescription drugs, dental professionals within a certain area for certain
care, and vision care. You can use the money in your procedures. Reasonable and Customary rates may
HSA to pay for qualified medical expenses now, or in the apply to out-of-network charges.
future, for your expenses and those of your spouse and ● Specialist – A provider who has specialized training
dependents, even if they are not covered by the HDHP. in a particular branch of medicine (e.g., a surgeon,
● Health Reimbursement Arrangement (HRA) – A fund cardiologist or neurologist).
you can use to help pay for eligible medical costs not ● Specialty drugs – A drug that requires special handling,
covered by your medical plan. Funds are contributed to administration or monitoring. Most can only be filled
the HRA by the company. by a specialty pharmacy and have additional required
approvals.

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