Helpful terms & resources Getting started
We've removed as much jargon as possible. But you’ll probably still encounter some terms as you enroll in and use your benefits, and we want you to be prepared!
Balance billing When you use an out-of-network medical or dental provider, they may bill you the difference between what they charge and the amount your insurance pays. Medical : balance billing is in addition to – and does not count towards – your out-of-pocket maximum. Coinsurance After you ’ ve met your deductible, you ’ re sometimes responsible for a percentage of the cost of the medical care, dental care, or prescription medication you received. This percentage is coinsurance.
Primary care physician A primary care physician ( PCP )is your main medical doctor – usually a general practitioner (GP), family doctor, internist, OB/ GYN, or pediatrician (for children). Referral/pre-authorization Some specialty medical providers and services require a referral from a primary doctor. These may include - but are not limited to - cardiology, psychiatry, orthopedic surgeons, rheumatology, surgery, and imaging (CTor MRI). Have questions? Your advocate is here to help you with all things benefits. See their contact information on the next page. Annual Notices We’re required to tell you about certain rights and responsibilities you have as an employeeofASCD+ISTE. You can request a paper copy at no charge from: CaraWynn Manager, Compensation & Benefits 1-703-575-5614 x5614 cara.wynn@ascd.org
Deductible The amount you ’ re responsible for paying in care expenses before the medical or dental plan starts paying deductible-eligible expenses. In-network In-network care is always your lowest-cost option. Networks are groups of medical, dental, and vision providers, pharmacies, and facilities that agree to discount the cost of their care or service. Out-of-pocket maximum The most you ’ ll payfor covered in- network medical care in a year. This includes your deductible, any coinsurance or copays, and prescription drugs. The out-of-pocket maximumdoes not include your premium(the amount you payfor coverage), non- covered expenses, or out-of- network care that ’ s been balance billed.
Copay A flat fee you pay each time you receive a copay-eligible medical,
dental, or vision service or prescription medication.
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