Tacodeli
Key Terms to Remember
Plan Types
c ollege oF b usiness Managemen
Out-of-Pocket Maximum This is the total amount you can pay out of pocket each calendar year
POS – Combines aspects of a PPO and HMO to manage cost
t Account Marketing Banking Finance HMO – A network that requires you to select a Primary Care Physician (PCP) who coordinates your health care EPO/PPO – A network of doctors, hospitals and other health care providers
before the plan pays 100 percent of covered expenses for the rest of the
calendar year. Most expenses that meet provider network requirements
HDHP – A plan that has higher cost sharing (e.g. deductible), but
count toward the annual out-of-pocket maximum, including expenses
paid to the annual deductible*, copays and coinsurance.
typically also lower monthly premiums.
*Except for Grandfathered medical plans
Copays and Coinsurance These expenses are your share of cost paid for covered health care
c ollege oF a rts & s cience Humanities Annual Deductible The amount you have to pay each year before the plan starts paying a portion of medical expenses. All family members’ expenses that
services. Copays are a fixed dollar amount, and are usually due at the
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time you receive care. Coinsurance is your share of the allowed amount
count toward a health plan deductible accumulate together in the
charged for a service, and is generally billed to you after the health
aggregate; however, each person also has a limit on their own
insurance company reconciles the bill with the provider.
individual accumulated expenses (the amount varies by plan).
The Value of Preventive Care Wellness and Health Management
Understanding the full value of covered benefits allows you to take responsibility for maintaining good health and incorporating healthy habits into your lifestyle. Some examples include getting regular physical examinations, mammograms and immunizations. Through the plans offered by Tacodeli , all covered individuals and family members are eligible to receive routine wellness services like these, at no cost; all copays, coinsurance, and deductibles are waived. Which Preventive Care Services Are Covered? The US Preventive Services Task Force maintains a regular list of recommended services that all Affordable Care Act (i.e. Health Care Reform) compliant insurance plans should cover at 100% for in-network providers. Below is a list of common services that are included in the plans offered this year:
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Routine Physical Exam
Routine Colorectal Cancer Screening
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Well Baby and Child Care
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Routine Prostate Test
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Well Woman Visits
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Routine Lab Procedures
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Immunizations
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Routine Mammograms
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Routine Bone Density Test
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Routine Pap Smear
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Routine Breast Exam
▪ Smoking Cessation Programs
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Routine Gynecological Exam Screening for Gestational Diabetes Obesity Screening and Counseling Routine Digital Rectal Exam
▪ Health Education/Counseling Services ▪ Health Counseling for STDs and HIV
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Testing for HPV and HIV
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▪ Screening and Counseling for Domestic Violence
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Routine Colonoscopy
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This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.
2025 Employee Benefit Guide
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