Networks
Only in-network providers are covered. Typically need referral for a specialist.
HMO
You must pay this before your rx coverage kicks in
Rx deductible
a fixed out-of-pocket amount paid by an insured for covered services
Copay
Pays a fixed amount for covered services.
Indemnity Plan
you may use in-network or out-of-network providers.
PPO
List of drugs covered by the plan
Formulary
a specified amount of money that the insured must pay before an insurance company will pay a claim.
Deductible
A plan with a higher deductible than a traditional insurance plan. Typically paired with HSA
High deductible health plan
has a local network, referrals not needed, does not cover out-of-network.
EPO
Similar to brand name drugs but usually less expensive
Generic
The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible
Coinsurance
Short-Term
A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. Referrals for specialists.
POS
Import drugs from Canada
An out-of-pocket maximum is the most you have to pay per year for covered healthcare services
Coinsurance
Inexpensive coverage for foreign travel
Travel Insurance
Pays based on medicare reimbursement rates.
Reference Based Pricing
This guy can get wicked low prices on most drugs
Cyril Costello
Two types of deductibles
Aggregate and Embedded
This type of group plan offers the employer a rebate if claims are low.
Level-Funded