Terms to Know
As you learn more about the health care options available to you at Brandeis, you may come across some unfamiliar terms. Here’s a glossary to help you make sense of these terms:
Annual Maximum: Total dollar amount a plan pays during a calendar year toward the covered expenses of each person enrolled.
Coinsurance: A percentage of the medical costs, based on the allowed amount, you must pay for certain services after you meet your annual deductible.
Copayment (or copay): A set dollar amount you pay for network doctors’ office visits, emergency room services and prescription drugs.
Deductible: Total dollar amount, based on the allowed amount, you must pay out of pocket for covered medical expenses each calendar year before the plan pays for most services. The deductible does not apply to network preventive care and any services where you pay a copayment rather than coin-insurance. Some of your dental options also have an annual deductible, generally for basic and major dental care services.
Network: A group of health care providers, including dentists, physicians, hospitals and other health care providers, that agrees to accept pre-determined rates when serving members.
Out-of-Pocket Maximum: The maximum amount of coinsurance a plan member must pay towards covered medical expenses in a calendar year for both network and non-network services. Once you meet this out-of-pocket maximum, the plan pays the entire coinsurance amount for covered services for the remainder of the calendar year. Deductibles and copays apply to the annual out-of-pocket maximum.
Primary Care Provider (PCP): The health care professional who monitors your health needs and coordinates your overall medical care, including referrals for tests or specialists.
Provider: Any type of health care professional or facility that provides services under your plan.
Qualifying Event: An occurrence that qualifies an employee to make an insurance coverage change outside of an open enrollment period.
Service Area: