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The following are a few definitions which may be helpful when making your health plan choices. More definitions can be found in the Summary of Benefits and Coverage.
Covered Services. A medically necessary service or supply for which the benefit plan will reimburse expenses according to the plan’s limits.
Co-Payment. The fixed dollar amount you pay each time you receive specific services, supplies or prescriptions.
Deductible. The specified amount of covered medical expenses you pay for yourself and/or covered dependents each calendar year before any additional covered medical expenses are paid by the Plan. Applies to covered services noted as percentages.
Co-Insurance. After the annual calendar-year deductible met, co-insurance will apply. Co-insurance is your share of the cost of a covered service. The cost is calculated as a percent of the allowed amount for the service.
Out-of-Pocket Maximum. The maximum amount you pay in co-insurance for covered expenses in a calendar year before the Plan pays 100%.
Usual, Customary & Reasonable (UCR). A fee usually established by health insurance or government agency that is considered to be the “usual” cost of a specific medical service. The fee is commonly based on the amount the company or agency will pay for that service and may vary with geographic area.
Generic Prescription Drug. A prescription drug that is produced by more than one manufacturer. It is chemically the same as brand and usually costs less than the brand name prescription drug for which it is being substituted and will produce comparable effective clinical results.
Brand Name Prescription Drug. A prescription drug that has been patented with the brand name and is produced by the original manufacturer under that brand name.