Glossary of Terms
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 par ts or functions (i.e. , limbs, speech, eyesight, or hearing). 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 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 amount you must pay for covered services before your plan coinsurance is applied. The deductible star ts 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, your plan coinsurance is applied. Embedded Out-of-Pocket Maximum 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 drug benefits. Generic Drugs Are created to be the same as an existing brand name drug in dosage, safety, effectiveness, strength and quality, but cost less. 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.
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