Allowed amount – The maximum amount used to determine the cost of covered health care services. May also be called allowable charge, eligible expense, payment allowance, or negotiated rate.

Brand-name drugs – Drugs approved by the FDA that are under patent to the original manufacturer. They are only available under the original manufacturer’s brand name.

Claim – A provider’s request to your plan administrator asking to be paid for a service you’ve received.

Coinsurance – The percentage of the cost you pay for covered health care services, after you meet your calendar-year deductible.

Deductible – The amount you pay out of pocket for health care each calendar year before the plan begins to share in the cost of covered services.

Explanation of Benefits – After you get care, you’ll receive an Explanation of Benefits (EOB) from your health care provider. The EOB provides information about how your claim was paid, including how much you owe or will be reimbursed.

Generic drugs – Drugs that are approved by the FDA as a therapeutic equivalent to the brand-name drug; has the same active ingredient as the brand-name version but at a lower cost.

Health Savings Account (HSA) – Special savings account that comes with a HDHP. You save on taxes in three ways: no taxes on your contributions, no taxes when you use the money to pay for eligible medical expenses, and no taxes on interest earned on your account.

In-network – The facilities, providers, and suppliers your health plan has contracted with to provide covered health care services.

Maintenance medications – Drugs that are prescribed to treat chronic health conditions—such as asthma, diabetes, high blood pressure, or high cholesterol—and are taken on an ongoing, regular basis to maintain health.

Non-preferred drugs – Drugs that are listed under “non-preferred” generally have higher copays than preferred brand-name drugs.

Out-of-network – Providers that are not in the medical plan network or have not contracted with medical plan provider and have not agreed to charge certain rates for certain services.

Out-of-pocket maximum – The most you’ll pay for covered health care services in a calendar year. Once you reach it, the plan pays 100% of the costs for covered services for the rest of the year.

Preferred provider organization (PPO) – A PPO is similar to a traditional fee-for-service plan, but you must use doctors in the PPO provider network or you will pay a higher coinsurance (percentage of charges) if you don’t. A PPO allows you to select most providers without a referral. You typically must meet an annual deductible before some benefits apply. You are responsible for a certain coinsurance amount, and the plan pays the balance, up to the allowable amount. You get maximum benefit coverage when you use the PPO network of physicians and hospitals.

Preventive care – Depending on your age and gender, your medical plan provides preventive services (such as screenings, immunizations, and exams) at no cost to you if you visit a participating provider and claims submitted are coded correctly. Follow-up testing for a diagnosed medical condition will generally not be covered as preventive.

Specialty medications – These are drugs that are used to treat complex or chronic conditions that usually require close monitoring, such as multiple sclerosis, hepatitis, rheumatoid arthritis, cancer, and other conditions that are difficult to treat with traditional therapies. Specialty drugs are obtained from pharmacies in our medical plan networks and may require prior authorization.