Video Library
HSA Overview
HSA Eligible Expenses
HSA Tax Advantages
HSA Eligibility
HSA Shopping Tips
Moving to an HSA Plan
Health FSA Overview
7 Tips for Healthcare Spending
Know Where to Go for Care
Preventive Care
Intro to Benefit Payments
Glossary of Terms
BALANCE BILLING
When you are billed for the difference between the provider’s actual charge and the amount reimbursed under the medical, dental or vision plan. This should only occur when you go outside of the provider network.
Balance billing does not apply toward your deductible or out-of-pocket maximum.
BRAND NAME DRUG
A drug sold under the name of the company that made it and that is protected by a patent.
A brand name drug can only be sold by the company holding the patent. You can get a brand name drug either by prescription or over the counter.
CLAIM
A request for a benefit (including reimbursement of a health care expense) made by you or your health care provider to your health insurer or plan for items or services you think are covered.
COINSURANCE
The percentage of the cost you pay for covered services after you meet your deductible.
COPAY (COPAYMENT)
A flat fee you pay for a covered healthcare service. You will typically pay your copay at the time of service, and then the plan will pay any remaining amount.
DEDUCTIBLE
The amount you are required to pay each year before certain benefits are paid for by the plan. Once you meet the deductible amount, expenses are covered by the plan based on the coinsurance percentage or copayment amount.
The deductible resets on Jan. 1 each year.
EVIDENCE OF INSURABILITY (EOI)
Information about your health that an insurance company uses to decide if you can be covered.
GENERIC DRUG
A copy of a brand name drug.
Generic drugs are required to have the same active ingredient, strength, dosage form, and method of administration as their brand-name counterparts.
GUARANTEE ISSUE
Guaranteed issue refers to health insurance coverage that is guaranteed to be issued to applicants regardless of their health status, age, or income.
HEALTH SAVINGS ACCOUNT (HSA)
An HSA is a special, tax-advantaged, interest-bearing savings account you can use for qualified healthcare expenses such as your deductible, copayments, and other out-of-pocket expenses.
HIGH DEDUCTIBLE HEALTH PLAN (HDHP)
A plan with a higher deductible than a traditional insurance plan. You pay more health care costs yourself before the insurance company starts to pay its share (your deductible). An HDHP can be combined with an HSA, allowing you to pay for certain medical expenses with money free from federal taxes.
IN-NETWORK
The doctors, hospitals, and other healthcare providers your insurance company has contracted with to provide services at discounted rates. You will pay less when you use in-network providers. Some plans will not cover the care you get outside of the network.
MAIL-ORDER PHARMACY
A service that lets you order your prescription drugs online, by mail or by phone, and then delivers your prescription to your home by mail.
OUT-OF-NETWORK
Relating to an out-of-network provider or health care services provided outside of your plan's network.
OUT-OF-POCKET MAXIMUM
The most you pay in a year for covered services. If you reach the OOPM, the plan pays 100% of covered expenses for the rest of the calendar year.
PLAN YEAR
The plan year refers to Jan. 1 through Dec. 31.
PREFERRED PROVIDER ORGANIZATION (PPO) PLAN
A type of health insurance plan that lets members use any health care provider, but will usually pay more of the member's costs when they get services from in-network providers.
PREMIUM
The amount that must be paid for your health insurance or plan in order to have coverage.
RETAIL PHARMACY
A pharmacy that sells medicine and related products at retail prices. Retail pharmacies can be independent, chain, supermarket, or mass merchandiser pharmacies that are licensed by the state. They are often located in drug stores and groceries.
SPECIALTY DRUG
A type of prescription drug that, in general, requires special handling or ongoing monitoring and assessment by a health care professional, or is relatively difficult to dispense. Generally, specialty drugs are the most expensive drugs on a formulary (the plan's drug list).
QUALIFYING LIFE EVENT (QLE)
A life event that permits you to change your benefits mid-year.
Some examples include:
- Birth of a child
- Marriage/divorce
- Death of a dependent
- Loss of other coverage
Printables
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Tips to Save Money
01 | Save the emergency room for true emergencies
Only visit the emergency room if you have a life- or limb-threatening emergency. If you need care when your doctor’s office is closed, check your area for an urgent care location or use virtual care instead.
02 | Use in-network providers
Your medical, dental and vision costs increase greatly when you visit a provider who is not in your plan’s network. Always confirm your provider is in your network, especially when being referred to another provider or facility for services.
03 | Get your annual checkup
You and your dependents should visit the doctor annually for health screenings and tests. Your plan covers preventive services at 100%.
04 | Choose generic prescriptions
Ask your doctor or pharmacist to give you generic prescriptions instead of brand-name. Generic drugs are cheaper and are just as effective.
05 | Take advantage of the mail-order pharmacy program
Save time and money by using the mail-order prescription drug program for your maintenance prescriptions. Check with Express Scripts (or your local plan) for more details.
