Accidental Death and Dismemberment (AD&D) AD&D covers the unintentional death or dismemberment of the insured. Dismemberment includes the loss, or the loss of use, of body parts or functions (i.e., limbs, speech, eyesight, or hearing). Coinsurance Coinsurance refers to the percentage of charges you and your plan will pay for covered services. For example, if your plan has a coinsurance split of 80/20, this means your plan will pay 80 percent of charges and you will pay 20 percent of charges. Copay A copay is a fixed dollar amount you pay for covered services in addition to what the plan pays. The copay is normally paid at the time of your visit. Deductible The deductible is the amount you must pay for covered services before your plan coinsurance is applied. The deductible starts over every January 1. Embedded Deductible In a health plan with an embedded deductible, no single individual on a family plan will have to pay a deductible higher than the individual deductible amount. Once you meet the individual deductible, In a health plan with an embedded out-of-pocket maximum, no single individual on a family plan will have to pay more than the individual out-of-pocket maximum amount. Once you meet the individual out-of-pocket maximum amount, your plan begins to pay 100% for the individual’s expenses for the remainder of the year. Flexible Spending Accounts (FSAs) FSAs allow associates to set aside pre-tax funds from their paychecks to accounts that can be used to pay for qualified medical or child care expenses. Formulary A formulary is a list of generic and brand name drugs covered by an insurance plan offering prescription your plan coinsurance is applied. Embedded Out-of-Pocket Maximum
Health Reimbursement Account (HRA) An HRA is an employer-funded account offered in combination with a health plan. The money in your HRA is used to pay expenses applied to your health plan copays, deductible and coinsurance. Health Savings Account (HSA) An HSA is a tax-advantaged savings account offered in combination with a high deductible health plan. The account can be funded by your employer and by you with pre-tax dollars from your paychecks. It comes with a debit card which can be used to pay qualified out-of-pocket medical expenses, such as those applied to your health plan deductible and coinsurance, as well as dental and vision expenses. High-Deductible Health Plan (HDHP) An HDHP is a health insurance plan with lower premiums and a higher deductible than a traditional health plan. You pay 100% of the cost of your non- preventive health care and prescriptions until you meet your deductible. Once you meet your deductible, the plan coinsurance is applied. Preferred Brand Drugs Preferred brand drugs are medications for which generic alternatives are not available and cost less than non-preferred brand drugs. Preventive Care Preventive Care is routine health care services to prevent illnesses, disease, or other health problems. It includes most vaccines, screenings, and annual check-ups and is typically covered at 100% under health plans. Non-Preferred Brand Drugs Non-preferred brand drugs are medications that have alternative generic or preferred brand drugs The out-of-pocket maximum is a specific limit for the total amount you will pay for covered health costs during the plan year. This includes amounts applied as copays, deductible and coinsurance. If you meet the out-of-pocket maximum, your health plan will pay 100% of your covered health care costs for the available and cost more. Out-of-Pocket Maximum
drug benefits. Generic Drugs
rest of the year. Specialty Drugs
Generic drugs are created to be the same as an existing brand name drug in dosage, safety, effectiveness, strength, and quality, but cost less.
Specialty drugs are high-cost medications used to treat complex, chronic conditions such as cancer, rheumatoid arthritis, and multiple sclerosis.
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