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: › Deductible: Dollar amount you must pay for year after the out-of-pocket maximum is 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. Which Medical Plan is the Best Additionally, each family member has an 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. › Cover the same basic medical services Under the Health Savings plan (HSA), the family › deductible must be reached, either by an C over the same network of doctors, hospitals individual or by the family, before services will and health care specialists who deliver quality be paid by the insurance company. There is no care according to network standards and have individual deductible under the HSA plan. agreed to lower, preferred rates for covered › Coinsurance: Percentage of the cost for services. eligible medical expenses that you pay after However, depending on the plan selected, your you meet the deductible. For example, under share of the cost of the medical services you the Health Savings Plan, after you meet the receive differs. deductible, the plan will pay 80% of covered NETWORK PLAN costs and you pay the remaining 20% up to the › Higher biweekly pr emium cost for coverage plan’s out-of-pocket maximum limit. The 20% is › C ost of care (deductible amounts and out-of your coinsurance. pocket limit) lower than the Health Savings › Copayment (or copay): A 昀椀xed amount that Plan you must pay for a service. Copays can vary HEALTH SAVINGS PLAN (HSA) depending on the service you receive. › P ay less in biweekly premium cost for › Network Providers: Providers who have agreed coverage to lower rates for services. The UnityPoint Health › C ost of care (deductible amounts and out-of- medical plans provide bene昀椀ts for covered pocket limit) will be higher than the Network services provided by network providers. Plan › Out-of-Pocket Maximum (OOPM): Maximum › UnityP oint Health contributes to your Health dollar amount that you pay for eligible expenses Savings Account to help offset out-of-pocket in a calendar year. The plan pays 100% of costs eligible expenses for the rest of the calendar | 5 |