Understand Your Benefits - Benefits Terminology

26.02.24 05:27 PM Comment(s) By Team

BENEFITS TERMINOLOGY

8 words to know about your benefits plans

Balance billing

When you use an out-of-network medical or dental provider, they may bill you the difference between what they charge and the amount your insurance pays. Medical: balance billing is in addition to and does not count toward your out-of-pocket maximum.

Copay

A flat fee you pay each time you receive a copay-eligible medical, dental, or vision service or prescription medication.

In-network

In-network care is always your lowest-cost option. Networks are groups of medical, dental, and vision providers, pharmacies, and facilities that agree to discount the cost of their care or service.

Primary care physician

A primary care physician (PCP) is your main medical doctor – usually a general practitioner (GP), family doctor, internist, OB/GYN, or pediatrician (for children).

Coinsurance

After you've met your deductible, you're sometimes responsible for a percentage of the cost of medical or dental care or prescription medication you received. This percentage is coinsurance.

Deductible

The amount you’re responsible for paying in care expenses before your plan starts paying deductible-eligible expenses.

Out-of-pocket maximum

The most you’ll pay for covered in-network medical care and prescription drugs in a year. This includes your deductible, coinsurance, and copays. The out-of-pocket maximum does not include your premium (what you pay for the plan), non-covered

expenses, or out-of-network care that’s been balance billed

Referral/pre-authorization

Some specialty medical providers and services require a referral from a primary doctor. These may include - but are not limited to - cardiology, psychiatry, orthopedic surgeons, rheumatology, surgery, and imaging (CT or MRI).

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