2018 Buchanan Hauling Benefit Guide
Important Definitions BENEFICIARY: The person or persons you name to receive benefits in the event of your death. You can change your beneficiary designations at any time. However, if you are married the government requires your beneficiary to be your spouse. PRIMARY BENEFICIARY: The entire death benefit will be paid in equal shares to the primary beneficiary or beneficiaries who survive you. CONTINGENT BENEFICIARY: If no beneficiary survives you, the entire death benefit will be paid to the contingent beneficiaries. A contingent beneficiary will receive a benefit if ALL primary beneficiaries predecease the participant. COINSURANCE: The percentage you pay for covered medical services. For example, if the insurance plan covers 80% and you are responsible for 20%. That 20% is coinsurance. COPAY: The flat dollar amount that you pay at the time you receive health care services. For example, the In- Network Only PPO plans have a $30 copay for visits to your primary care doctor. DEDUCTIBLE: The dollar amount that you pay out-of- pocket before the insurance plan begins to pay. EMERGENCY: An unforeseen medical condition that, if not treated immediately, could seriously jeopardize or impair your health, such as a suspected heart attack, severe burns, or broken bones. HIGH-DEDUCTIBLE HEALTH PLAN: A medical plan that meets requirements set by the IRS for a minimum deductible amount and a maximum out-of-pocket limit for in-network services. Employees in plans that meet these requirements (like the HSA) can open a Health Savings Account. IN-NETWORK PROVIDER: A physician, hospital, lab, pharmacy, or other health professional or facility that participates in United Healthcare’s network. You will receive the negotiated reduced rate from In-Network providers. MEDICARE: Medicare is health insurance for people age 65 or older, under 65 with certain disabilities, or any age with End-Stage Renal Disease (permanent kidney failure). There are four types of Medicare. Medicare Part A helps cover inpatient care in hospitals, skilled nursing facilities, and hospice and home health care. Generally there is no monthly premium if you qualify and paid Medicare taxes while working. Medicare Part B helps cover medical services like doctors’ services, outpatient care, and other
medically necessary services that Part A doesn’t cover. You need to enroll in Medicare Part B and pay a monthly premium determined by your income, along with a deductible. Many people also purchase a supplemental insurance policy, such as a Medigap plan, to handle any Part A and B coverage gaps. Medicare Advantage Plans, also known as Medicare Part C , are combination plans managed by private insurance companies approved by Medicare. They typically are a combination of Part A, Part B, and sometimes Part D coverage, but must cover medically- necessary services. These plans have discretion to assign their own copays, deductibles, and coinsurance. Medicare Part D is prescription drug coverage, and is available to everyone with Medicare. It is a separate plan provided by private Medicare-approved companies, and you must pay a monthly premium. MEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP): If you are eligible for health coverage from your employer, but are unable to afford the premiums, some States have premium assistance programs that can help pay for coverage. These States use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage, but need assistance in paying their health premiums. OUT-OF-NETWORK PROVIDER: A health care provider that does not participate in United Healthcare’s health care network. Costs to visit an out-of-network provider are almost always higher. Plus you may be liable for costs over usual and customary charges (see below) at out-of-network facilities. OUT-OF-POCKET-MAXIMUM: This includes your deductible and any coinsurance or copays. This is your “worst-case scenario.” URGENT CARE: An acute, unforeseen illness or injury that requires prompt treatment, such as sprains and strains, sore throat, flu-like symptoms, vomiting, fever, cramps, rashes, or earaches. USUAL AND CUSTOMARY CHARGE: The average fee for a specific procedure in a given geographic region. If you go out-of-network, you will be responsible for any charges over the “usual and customary” cost for the same procedure at an in-network facility in that region. For example, if the set “usual and customary” rate for a procedure is $50 in- network and you visit a physician out-of-network that charges $75, United Healthcare will only provide insurance on the $50. You will pay the balance plus any copay or coinsurance.
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