Health Insurance Key Health Care Terms We’ve compiled this list of health care terms to help you navigate this section of the enrollment guide: › year after the out-of-pocket maximum is Deductible: Dollar amount you must pay for covered care each calendar year before the reached - providing 昀椀nancial protection for medical plan pays bene昀椀ts for services. The you by limiting your out-of-pocket expenses in deductible doesn’t apply to every service so a given calendar year. The out-of-pocket limit be sure to check out the summary schedule is a combined amount for both medical and of bene昀椀ts. Under the Network plan, the family prescription coverage under each medical plan. must collectively satisfy the family deductible. Additionally, each family member has an Which Medical Plan is the Best individual deductible in addition to the overall Choice for Me? family deductible. Meaning if an individual in You will have the choice to waive medical the family reaches his or her deductible before coverage or select coverage from one of two the family deductible is reached, his or her HealthPartners medical plans. Both medical plans: services will be paid by the insurance company. › Under the Health Savings plan (HSA), the family Cover the same basic medical services deductible must be reached, either by an › C over the same network of doctors, hospitals and individual or by the family, before services will health care specialists who deliver quality care be paid by the insurance company. There is no according to network standards and have agreed individual deductible under the HSA plan. to lower, preferred rates for covered services. › Coinsurance: Percentage of the cost for However, depending on the plan selected, your eligible medical expenses that you pay after share of the cost of the medical services you you meet the deductible. For example, under receive differs. the Health Savings Plan, after you meet the NETWORK PLAN deductible, the plan will pay 80% of covered › Higher biweekly pr emium cost for coverage costs and you pay the remaining 20% up to the › C ost of care (deductible amounts and out-of plan’s out-of-pocket maximum limit. The 20% is your coinsurance. pocket limit) lower than › the Health Savings Plan Copayment (or copay): A 昀椀xed amount that HEALTH SAVINGS PLAN (HSA) you must pay for a service. Copays can vary depending on the service you receive. › P ay less in biweekly premium cost for › coverage Network Providers: Providers who have agreed › C ost of care (deductible amounts and out-of- to lower rates for services. The UnityPoint Health pocket limit) will be higher than the Network medical plans provide bene昀椀ts for covered Plan services provided by network providers. › › UnityP oint Health contributes to your Health Out-of-Pocket Maximum (OOPM): Maximum Savings Account to help offset out-of-pocket dollar amount that you pay for eligible expenses costs in a calendar year. The plan pays 100% of eligible expenses for the rest of the calendar | 5 |