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Health benefits include a variety of terms that can be new or unfamiliar. This page provides definitions for common medical and prescription drug terms to help you better understand how your coverage works and what you may pay for care.
Drugs that have trade names and are protected by patents. Brand-name drugs are generally the costliest choice.
The percentage of a covered charge paid by the plan.
A flat dollar amount you pay for medical or prescription drug services regardless of the actual amount charged by your doctor or healthcare provider.
The annual amount you and your family must pay each year before the plan pays benefits.
A health plan with a high deductible used in conjunction with a health reimbursement account (HRA) or a health savings account (HSA).
A fund you can use to help pay for eligible medical costs that are not covered by your medical plan. Funds are contributed to the HRA by your employer.
A fund you can use to help pay for eligible medical costs that are not covered by your medical plan. Both employers and employees may contribute to this fund; employees do so through pre-tax payroll deductions.
Use of a health care provider that participates in the plan's network. When you use providers in the network, you lower your out-of-pocket expenses because the plan pays a higher percentage of covered expenses.
Services provided to an individual during an overnight hospital stay.
Mail-order pharmacies generally provide a 90-day supply of a prescription medication for the same cost as a 60-day supply at a retail pharmacy, and they offer the convenience of shipping directly to your door.
Use of a healthcare provider that does not participate in the plan's network.
The maximum amount you and your family pay for eligible expenses each plan year. Once your expenses reach the out-of-pocket maximum, the plan pays 100% of eligible expenses for the remainder of the year.
Services provided to an individual at a hospital facility without an overnight hospital stay.
A physician (generally a family practitioner, internist, or pediatrician) who provides ongoing medical care. A primary care physician treats a wide variety of health-related conditions and refers patients to specialists, as necessary.
A physician who has specialized training in a particular branch of medicine (e.g., a surgeon, gastroenterologist, or neurologist).