Frequently Asked Questions

A: A provider network is a group of healthcare professionals who have come together to offer bundled services at a contracted rate. If your plan works with a specific network, those providers are designated as ‘in-network’.

A: A deductible is the annual out-of-pocket limit that you are responsible for paying before the health plan will cover the full cost of medical treatment. Check your plan documents to see what your deductible is and whether you are required to pay for covered services after you meet that deductible.

A: A copay is the amount you are required to pay out of pocket for medical visits and/or prescriptions in addition to what your health plan will pay.

A: Coinsurance is a form of cost sharing between plan members and the health plan. You will be required to pay a share of the payment made against your claim, usually represented as a percentage. For example, if you have an 80/20 plan, your health plan would cover 80% of the claim cost, and you would pay the remaining 20%.

A: An out-of-pocket maximum is the threshold of what you will be required to pay for covered services within a plan year. After you meet your out-of-pocket maximum through copayments, coinsurance and deductibles, your plan pays 100% of the cost of covered benefits for the rest of the plan year. Check your plan document to see what medical payments are included in your out-of-pocket maximum.

A: A dependent is a spouse or child that is covered under your health plan.

A: The effective date is the date that your coverage begins.

A: Plans use the term in-network, preferred, or participating for providers in their network. A healthcare professional, hospital or pharmacy is in-network if that provider is a part of your health plan’s preferred providers. These providers generally offer a discounted rate as negotiated by the insurance company. Be aware that your in-network provider or hospital may be out-of-network for some services. See your plan documents to review how different providers are covered.