Medical Terms
A member must pay $2,000 before the plan starts sharing cost.
What is a Deductible?
An employee likes the idea of putting away pre-tax dollars to help pay eligible medical expenses with a qualifying plan.
What is an HSA?
An employee needs more than cleanings this year and wants to know the most the dental plan will pay during the plan year.
What is the dental annual maximum?
An employee enrolls in life insurance and needs to name the person or entity who would receive the benefit
What is a beneficiary?
Employee sees a doctor and is surprised by a bill because they hadn't met this first
What is the deductible?
A member must pay $25 every time they visit their primary care doctor.
What is a Copay?
An employee rarely uses care and is comfortable taking on a higher deductible if the paycheck cost is lower.
What is an HSA or high deductible plan?
An employee is buying new glasses and wants to know how much the vision plan contributes toward frames.
What is the frame allowance?
An employee wants life coverage during initial eligibility without answering health questions, up to the plan’s limit.
What is guarantee issue?
Employee's medication isn't covered because it isn't on this list.
What is the formulary?
A member owes 20% of the bill after meeting the deductible.
What is coinsurance?
Plan A has a $6,600 deductible. Plan C has a $600 deductible. The employee wants less upfront medical cost exposure.
What is Plan C?
An employee goes for exams, cleanings, and X-rays. These services are usually grouped into this dental category.
What is preventive dental care?
An employee is out of work for several weeks after a covered condition and needs income replacement for a shorter period.
What is short-term disability?
Employee goes to an out-of-network doctor and pays much more than expected.
What is the network?
A member has already spent $8,000 on covered in-network healthcare this year. They don't have to pay any more covered cost sharing.
What is the out-of-pocket maximum
An employee expects frequent doctor visits and likes predictable office visit costs more than taking on a high deductible.
What is a copay plan?
A parent is asking whether braces are covered for a child.
What is orthodontia?
An employee cannot work for eight months because of a covered illness and needs longer income protection.
What is long-term disability?
Employee thought braces were covered but forgot to check this benefit.
What is orthodontia?
An employee is planning knee surgery this year and wants protection from large medical bills.
What is the out-of-pocket maximum?
Two plans cost about the same per paycheck, but one has a much higher deductible. This is the next number the employee should compare to understand worst-case risk.
What is the out-of-pocket maximum?
An employee wears contacts every day and barely uses glasses. This vision benefit probably matters most to them.
What is the contact lens allowance?
An employee assumes their life insurance amount will stay the same forever, but the policy reduces the benefit at certain ages.
What is age reduction?
Employee picked the cheapest medical plan and later learned they could owe $6,000 before the plan pays much of the cost.
What is an HSA/high deductible plan