Definitions
Benefits can be confusing, but you don’t need to be a benefits specialist to understand what is available to you. We’ve made these definitions available so you can make the most educated and best decision for yourself and your family.
Premium:
The amount you pay out of your paycheck to be covered by the plan.
Deductible:
Most general: The amount you must pay each calendar year before the plan begins paying toward covered services. For most PPOs and some HMOs: The amount you must pay each calendar year before the plan begins paying toward certain covered services such as emergency room visits and hospitalizations.
Out-of-pocket maximum:
• The most you will be required to pay out of your pocket for covered health care services in any one calendar year. The out-of-pocket maximum does not include premium payments taken from your paycheck. • Embedded out-of-pocket maximum: If your spouse and/or children are covered by the plan, the individual out-of-pocket maximum applies to each covered family member (capped at family amount). Are you covering your spouse and/or children? • PPO and HMO plan members: If your spouse and/or children are covered by the plan, the individual deductible and out-of-pocket maximum apply to each covered member of the family (capped at family amount).
Plan deductibles and out-of-pocket maximums reset on January 1 each year.
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