Benefits Glossary
Definitions of the terms you'll see throughout the benefits guide.
Deductible
The amount you owe for healthcare services before your insurance begins to pay its portion. For example, if your deductible is $1,000, your plan does not pay anything until you've paid $1,000 for covered services. This deductible may not apply to all services, including preventive care.
Coinsurance
Your share of the cost of a covered healthcare service, calculated as a percent of the allowed amount for the service, typically after you meet your deductible.
Copay
The fixed amount you pay for healthcare services received, as determined by your insurance plan.
Out-of-Pocket Maximum
The most you pay during the plan year before your health insurance begins to pay 100% of the allowed amount. This does not include your premium, out-of-network provider charges beyond the Reasonable & Customary, or healthcare your plan doesn't cover.
Network
A group of physicians, hospitals, and healthcare providers that have agreed to provide medical services to a health insurance plan's members at discounted costs.
High Deductible Health Plan (HDHP)
A plan option that provides choice, flexibility, and control when it comes to healthcare spending. Most preventive care is covered at 100% with in-network providers, and all qualified employee-paid medical expenses count toward your deductible and out-of-pocket maximum.
Health Savings Account (HSA)
A personal healthcare bank account funded by your or your employer's tax-free dollars to pay for qualified medical expenses. You must be enrolled in an HDHP to open an HSA. Funds contributed to an HSA roll over from year to year and the account is portable if you change jobs.
Flexible Spending Accounts (FSAs)
A special tax-free account you put money into that you use to pay for certain out-of-pocket healthcare costs. FSAs are 'use it or lose it,' so funds not used by the end of the plan year will be lost. Some Healthcare FSAs allow for a grace period or rollover into the next plan year.
Reasonable and Customary Allowance (R&C)
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. Also known as the UCR (Usual, Customary, and Reasonable) amount.