Brand-Name drug is a prescription drug for which the manufacturer has a patent. The name of the drug is usually the name assigned by the manufacturer.
Coinsurance is the percentage you pay for a medical service; for example, you pay 20% and the plan pays 80%.
Co-pay is a set amount you pay for a medical expense. For example, you pay a $20 co-pay for an office visit.
Deductible is the portion of covered charges you pay before the plan pays any benefits.
In-network providers participate in an established network, providing services to participants at negotiated rates that represent a discount from standard charges. When you receive services from this pre-selected group of providers, the plan provides a higher level of coinsurance.
Generic drug is a prescription drug which is a chemical equivalent copy of a Brand-Name drug. Generic drugs are formulated upon a manufacturer's Brand-Name drug patent expiration. Generic drugs are usually less expensive than branded drugs and are usually sold by their chemical formula or "generic" name. For example, Valium is a Brand-Name drug, whereas Diazepam is its chemically equivalent generic.
Out-of-pocket maximum - The maximum amount you will pay for covered medical services in any calendar year. The plan pays 100% of reasonable and customary expenses after you have met the out-of-pocket maximum.
Pre-certification is also known as "prior-authorization" or "pre-admission review." The process of pre-certification is determining the justification of certain procedures such as inpatient or outpatient surgery, diagnostic tests or physical therapy.
Preferred Provider Organization is a network of providers (hospitals, doctors, labs, etc.) who agree to provide healthcare services to participants at discounted fees. When you receive services with "in-network" providers you pay less. You are also covered if you receive services from "out-of-network" providers but you will pay more.
Price tag refers to the price associated with each Medical/Prescription Drug plan option.
Qualified status change is an event that allows you to make changes to your benefits outside the annual open enrollment period. Benefit changes that are made as a result of a status change must be consistent with the status change and must be made within 31 days from the date the event occurred. Status changes include marriage, divorce, death of a spouse or a dependent, the birth or adoption of a child, and a change in the employment status of you or your spouse. No changes other than qualified family status changes are permitted to be made until the next open enrollment period.