Coinsurance: This is the percentage of a covered health care expense that you pay, usually after you’ve met your deductible. For example, if the plan pays 80% of an expense, the other 20% is your coinsurance.
Copay: This is a flat-dollar amount you pay for a certain service. Normally, you’re expected to pay your copay at the time you receive the service (for example, when you go to the doctor).
Deductible: The amount of covered health care expenses you pay out of your own pocket before the plan begins to pay part of your expenses. PPO plans usually have a calendar-year deductible that applies to most covered expenses.
Eligible Expenses: The services and supplies eligible for reimbursement under your medical plan
Health Savings Account (HSA): A special account, tied to a Health Plan, where you contribute money on a pre-tax basis to use for health care expenses, including the deductible. Participating in an HSA or FSA will save you money on taxes.
In-Network Provider: Doctors, hospitals, labs, and other health care facilities that belong to a plan network. In most circumstances, you will pay less for your care when you use in-network providers.
Flexible Spending Account: A Flexible Spending Account allows you to contribute pre-tax money to use for certain non-medical expenses, such as eligible dental or vision care. Participating in a Flexible Spending Account will save you money on taxes.
Out-of-Network Provider: Health and Dental care providers who aren’t members of a network. In most circumstances, you’ll pay more for your care if you use and out-of-network provider than you would if you got the same services from an in-network provider.
Out-of-Pocket Maximum: A benefit that protects you from having to pay extremely high medical costs in one calendar year. After you reach your out-of-pocket maximum, your medical plan pays 100% of your covered medical expenses for the rest of that calendar year (copays and service-specific deductibles may still be required).
PPO (Preferred Provider Organization): A medical or dental care network plan that gives you the option to get care from an in-network provider or an out-of-network provider.
R&C (Reasonable & Customary) Charges and Fees: This term refers to the current range of fees charged for a particular service by providers in a geographic area. If you use out-of-network providers and you doctor or dentist charges more than the R&C charges in your area, you will have to pay the difference. Also, amounts you pay above the R&C charges don’t count toward your out-of-pocket limit.
Wellness Program: Comprehensive health program designed to maintain a high level of well being through proper diets, light exercises, stress management, and illness prevention.