Brand Name Drugs: A drug protected by a patent issued to the original innovator or marketer. The patent prohibits the manufacture of the drug by other companies as long as the patent remains in effect.
Coinsurance:The percentage of the cost shared by a medical or dental plan and a participant. For example if you have 80%/20% coinsurance, the plan would pay 80%, and you would pay the remaining 20%.
Consumer-Driven Health Plan (CDHP):These types of health care plans allow participants to actively manage more of their medical care. Because High Deductible Health Plans have high deductibles for which the participant is responsible, he or she determines how to best spend that money. HDHPs sometimes pay for services for which other health plans would not pay. Participants in these types of plans can use a Health Savings Account (HSA), which is funded by both associate and employer contributions. The money in this account can be used to pay for health-related services at an added tax advantage.
Deductible:The amount of expenses that must be paid out of pocket before a benefit plan will cover any expenses.
Dependent:A member of your family who is eligible to be covered for health and dental benefits from your health plan. Includes spouse (or qualified domestic partner, in some cases) and unmarried dependent children up to a certain age. See your Summary Plan Description for dependent eligibility rules.
Dependent Care Flexible Spending Account:A savings account that enables you to pay for dependent care (for either dependent children or disabled dependents) with tax-free dollars so that you can work. Some examples include day care, payment for someone who provides care in your home to your dependent, eligible day senior centers, after-school care and some summer day camps.
Durable Medical Equipment:Durable Medical Equipment (DME) is any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions and/or illnesses. Durable Medical Equipment (DME) consists of items which: • are primarily and customarily used to serve a medical purpose
Eligible Expense: Covered medical expenses for which a health insurance policy will provide benefits.
Flexible Spending Account (FSA): A savings account that enables you to pay expenses with tax-free dollars. For Dental & Vision Spending Account, some examples include vision and dental copayments and out-of-pocket dental and vision expenses. See IRS Publication 502 for a list of many qualified expenses. See Dependent Care Flexible Spending Account.
Generic Prescription Drugs:Contain the same active ingredients as Brand Name Prescription Drugs, but at less of a cost to the consumer. Most health plans require a member to pay higher costs if a patient chooses a Brand Name Prescription Drug when a Generic Prescription Drug is available.
Health Savings Account (HSA): A non-taxable account to pay certain expenses for those enrolled in a High Deductible Health Plan. HSAs may be funded by employers, associates or both.
High-Deductible Health Care Plan: A health insurance plan with lower premiums and higher deductibles than a traditional health plan.
Mental Health Services:Mental Health Services include the assessment, diagnosis, treatment or counseling in a professional relationship to assist an individual or group in alleviating mental or emotional illness, symptoms, conditions or disorders.
Network Providers (also called In-Network Providers or Participating Providers): Refers to providers (doctors, dentists, pharmacies, hospitals, labs and other health care professionals) that have agreed to charge plan participants a pre-negotiated discounted rate for services and treatment. When you go to a network provider, the plan generally will pay a higher level of benefits, and you will have lower out-of-pocket costs than you would when seeing an out-of network provider.
Non-Preferred Brand Named Drugs.These are brand-name drugs that are not included on the plan's formulary (list of preferred prescription drugs). Non-preferred brand-name drugs have higher coinsurance than preferred brand-name drugs. You pay more if you use non-preferred drugs than if you opt for generics and preferred brand-name drugs.
Out-of-Pocket Maximum:The maximum amount you pay out-of-pocket in a single year before the plan covers expenses at 100%. Included in the calculation are deductibles, and coinsurance. (Copayments are not included in OOP max.)
Preferred Brand Name Drug : A medication identified by a prescription-drug plan, preferred for both their clinical effectiveness and cost-effectiveness.
Preventive Care: Health care that focuses on wellness, emphasizing prevention, early detection and early treatment. Typically includes routine physicals, immunizations, well-baby care, mammograms, etc.
Primary Care Physician (PCP): A Primary Care Physician serves as your main contact when care is needed and will refer you to other providers/specialists as necessary.
Summary Plan Description (SPD): Legal documents, required by law by a benefit plan, summarizing the particulars of benefits plans.
Specialist:A specialist physician is a doctor who has completed advanced education and training in a specific field of medicine. Depending on your health insurance plan, you may need a referral from a primary care physician to see a specialist.
Specialty Drug:Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis, and multiple sclerosis.
Traditional Preferred Provider Organization (PPO): A type of health care insurance plan that allows you to use in-network doctors at a reduced rate but also covers you when you use out-of-network doctors (out-of-network doctors are more expensive).
|FSA||Flexible Spending Account|
|HSA||Health Savings Account|
|PCP||Primary Care Physician|
|PPO||Preferred Provider Organization|
|SPD||Summary Plan Description|