Basic Services: This is the percentage of the bill that is covered by your insurance for procedures designated as basic under your plan.
Beneficiary: This is an individual you have designated to receive a benefit amount.
Beneficiary Percent: The percentage of the benefit amount the beneficiary will receive.
Beneficiary Relationship: Your relationship to the beneficiary you have designated.
Benefit Amount: The dollar amount beneficiaries will receive.
Calendar Year Max: The maximum amount the plan will pay for covered services in a plan year.
Coinsurance: After your deductible is met, this is the percentage of costs you will pay for covered services.
Contact Lens Allowance: The amount covered for contact lenses.
Contact Lens Frequency: The number of months that must pass after a covered service before you can receive your next service.
Deductible-Family: The amount you will pay in total, for all covered individuals before your insurance carrier begins paying for eligible expenses. Once the family deductible is met, everyone in the family is covered even if their individual deductibles are not met.
Deductible-Single: The amount you will pay for each covered individual on your plan before your insurance carrier begins paying for eligible expenses for that individual.
Group Number: This number is unique to your company and is assigned by your insurance carrier. Healthcare providers and pharmacies use this to verify your coverage.
Effective Date: The date your plan coverage begins.
Emergency Room: The amount you pay to receive care for emergency services in a hospital facility.
Employer Contribution: The amount your employer contributes to your plan costs.
Exam Copay: A predetermined rate you will pay every time you have an eye exam.
Exam Frequency: The number of months that must pass after a covered service before you can receive your next service.
Expiration Date: The date when your FSA or HRA funds expire. Once your funds expire, they cannot be used.
Frame Allowance: The amount covered for frames.
Frame Frequency: The number of months that must pass after a covered service before you can receive your next service.
ID(Member ID): This number is unique to you and is assigned by your insurance carrier. Healthcare providers and pharmacies use this to verify your coverage.
In-Network Coverage: In-network providers have contracted rates they've pre-negotiated with insurance carriers. Typically you will pay less with an in-network provider.
Mail Order Copay: A predetermined rate you will pay for mail-order prescriptions.
Materials Copay: A predetermined rate that applies to the entire purchase of eyeglasses or contacts.
Major Services: This is the percentage of the bill that is covered by your insurance for procedures designated as major under your plan.
Monthly Benefit Amount: The amount you will receive per month if you qualify for long term disability.
Orthodontia Coverage: The percentage of the orthodontia expenses that you are responsible for.
Orthodontia Lifetime Maximum: The maximum dollar amount covered by your plan for orthodontia during your lifetime.
Orthodontia Limit: The age limit up to which members are eligible for orthodontia.
Out-Of-Network: Out-of-network providers do not have pre-negotiated rates with your insurance carrier. You may pay more for eligible services with an out-of-network provider.
Out of Pocket Max-Family: The most you will pay for covered services in a plan year for all enrolled individuals. When what you’ve paid toward individual maximums adds up to your family out of pocket max, your plan will pay 100% of the allowed amount for health care services for everyone on the plan. This does not include your payroll contribution.
Out Of Pocket Max-Single: The most you will pay for covered services in a plan year for each enrolled individual. Once this maximum is met through the individual’s deductible, copayments, and coinsurance, your health plan pays 100% of the costs of covered services. This does not include your payroll contribution.
Preventive Service: This is the percentage of the bill that is covered by your insurance for procedures designated as preventive under your plan.
Primary Care Physician: Your primary care provider that you can designate during enrollment.
Primary Copay: A predetermined rate you will pay every time you see your primary care physician.
Retail Rx Copay: A predetermined rate you will pay for retail prescriptions.
Rollover: The balance on your FSA or HRA account that can be rolled over to a new plan year after your plan expiration date.
RxBin: This identifies which insurance carrier will be billed for your prescription.
Rx Deductible: The amount you will pay before your insurance carrier will pay for eligible expenses on your prescription.
RxPCN: This is a secondary identifier that insurance carriers use for prescription billing.
Specialist Copay: A predetermined rate you will pay every time you see a specialist.
Urgent Care: The amount you pay to receive care for emergency services in an independent non-hospital facility.
Weekly Benefit Amount: The amount you will receive per week if you qualify for short term disability.
Your Contribution: The amount you pay for your plan.