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Health insurance safeguards you from considerable costs of hospital stays, surgical procedures, doctor visits, prescriptions, and preventive care. Unfortunately accidents and illness do happen. Even a minor illness or injury could create a major financial burden that could greatly impact you. Start here to review and reference some basic medical terminology!
For specific benefits questions that may not be addressed in our Benefits Guide, please see the following resources:
For specific benefits questions that may not be addressed in our Benefits Guide, please see the following resources:
Things To Consider When Choosing Your Health Plan
Things To Consider When Choosing Your Health Plan
Premium: How much will you pay per month for coverage?
Deductible: What is the amount you must pay out-of-pocket before coverage kicks in?
Copay & Coinsurance: What are the other costs will you be required to pay in order to access care?
Coverage of Medicines: Are your regular prescriptions covered by your plan?
What is a High Deductible Health Plan (HDHP)?
What is a High Deductible Health Plan (HDHP)?
A plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). A high deductible plan (HDHP) can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes.
What is a Health Maintenance Organization Plan (HMO)?
What is a Health Maintenance Organization Plan (HMO)?
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
HSA: Health Savings Account
HSA: Health Savings Account
HSA's are a 2 component arrangement of:
A qualified High Deductible Health Plan (HDHP), and
A Heath Savings Account
One can have (1) without (2) but not (2) without (1).
An HSA is an individual savings account! The unused funds in an HSA roll over from year to year and the account remains with the employee – even if the employee changes employers or retires. An HSA enables employees to save on taxes in several ways:
The money contributed is tax deductible, up to a legal limit.
The savings grow tax free.
Any money used to pay for qualified medical expenses is income tax free.
FSA: Flexible Savings Account
FSA: Flexible Savings Account
The FSA is an account funded by your elected, pre-tax payroll deductions and pays for health care and/or child/dependent care expenses that are not covered by our insurance plan. If you contribute a portion of your check you can save 25% to 40% in taxes. There are three types of FSA's available:
Medical FSA - Note: you cannot enroll in a Medical FSA if you are enrolled in a HDHP/HSA
Limited FSA
Dependent/Childcare FSA
Premium:
Premium:
The money you pay the insurance company to buy the plan. DSST covers a majority of this cost with the remaining amount deducted, pre-tax from your paycheck each month.
Deductible:
Deductible:
The amount you have to pay for your health care each year before your insurance starts paying for care. With a $3,000 deductible, for example, you pay the first $3,000 of covered services yourself. This resets ever calendar year (January 1).
Family Deductible:
Family Deductible:
Family plans often have both an individual deductible, which applies to each person, and a family deductible, which applies to all family members.
Co-payment:
Co-payment:
A copay is a flat-dollar amount you pay for specific covered services upon each visit to the provider. Your copay does not count towards the plan deductible, coinsurance or out-of-pocket maximum.
Co-insurance:
Co-insurance:
The percentage of costs of a covered health care service you pay after you've paid your deductible. For example, the plan may pay 80% while you pay 20%.
Out-of-Pocket Maximum:
Out-of-Pocket Maximum:
The maximum amount you will pay out of pocket for covered medical expenses per calendar year (January – December), including your deductible. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of covered benefits.
Preventative Care
Preventative Care
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems. Check-ups can include but are not limited to:
Shots for the flu, pneumonia or other illnesses
Tests for diabetes or other conditions
Pregnancy counseling and screenings
Cancer screenings, including colonoscopies and mammograms Preventive care isn’t limited to shots and screenings.
Prior Authorization:
Prior Authorization:
Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.
FSA: Flexible Spending Account:
FSA: Flexible Spending Account:
As FSA is a tax-advantaged account that lets you put money aside on a pre-tax basis to pay for a wide range of health and/or dependent care expenses (as defined by the IRS) not covered by your plan that you incur during the plan year. Unlike the HSA, any unused funds remaining after the plan year ends will be forfeited.
HSA: Health Savings Account:
HSA: Health Savings Account:
An HSA is a tax-advantaged savings account for high deductible health plan (HDHP) that lets you put money aside on a pre-tax basis to pay for a wide range of health care expenses (as defined by the IRS) not covered by your plan. Want to learn more...here is a list of qualified expenses.
HSA Contribution:
HSA Contribution:
This refers to a contribution, or “deposit,” an employee may make to his/her HSA, or a deposit made by the company to the HSA of an employee participating in the HDHP.
Formulary:
Formulary:
A medical plan’s formulary is a drug list of the most cost-effective outcome-based drugs. You pay less when using a drug on the plan’s formulary list.
Explanation of Benefits
Explanation of Benefits
The EOB is not a bill, although it will explain any charges that the insurance carrier paid and anything that the patient still owes or may have already paid (ie. co-pay). If the patient owes additional money after the insurance company has paid its portion, the medical provider will send a separate bill, which should match the patient’s portion listed on the EOB.
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