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Glossary of Health Plan Terms

Annual Deductible.

A deductible is the amount you pay for healthcare services before the insurance plan begins to pay for services. There is an amount for a single person to pay (individual deductible) and an amount for a family (2 or more people combined) to pay.

After you've paid the amount of the individual or family deductible, you will only have to pay for a portion of the cost of services. Some services list the cost as a copay amount, which means you don't have to meet a deductible first. You simply pay the copay amount for that service.

HSA Eligible?.

HSA means Health Savings Account. HSAs allow you to put money in a special savings account without paying income taxes on it. If you use this money to pay for approved medical expenses, it will not be taxed.

The account also earns interest, which is tax-free if spent on approved medical expenses. HSAs are not “use it or lose it” accounts; you can use the money to pay for approved medical expenses at any time.

You can continue saving an HSA as long as you are enrolled in an HSA-eligible health plan, which is usually limited to high-deductible health plans (HDHP). But you can spend the money in your HSA account on medical services at any time, even if you don’t have an HDHP at the time.

Monthly Premium.

The premium is the monthly cost you will pay for insurance coverage in this plan. Your premium is based on age, ZIP code, tobacco usage and number of family members to be covered. If any one of these items change, your premium could change.

Premium quotes may change based on information you provide when you actually enroll.

Out-of-Pocket Max.

This is the most you will pay for covered medical expenses (copayments, coinsurance, etc.) within the calendar year of the plan.

If you have an individual plan, the Out-of-pocket requirement is satisfied when you meet the individual Out-of-pocket limit for your plan.

If you have a family plan (two or more enrolled members), the entire family Out-of-pocket limit must be met before the plan will pay for the healthcare costs. However, if one Member of the family fulfills the individual Out-of-pocket limit, that family member’s health care services will be 100% paid by the plan through the calendar year. When the full family Out-of-pocket limit requirement is satisfied, all services will be 100% paid by the plan.

The annual Out-of-pocket limit includes deductible, coinsurance, and copayments (copays). It does not include non-covered charges.

Primary Care Visit.

This is the price you pay for a primary care doctor visit for an exam or when you are sick. It does NOT apply to visits for annual physicals or preventive services (like vaccines) which are free.

Your cost may be a copay (a fixed amount) or a coinsurance (a percentage of the total cost for the visit).