This is a doctor responsible for your basic care. They may also provide referrals for specialized care.
This type of care is used to help you stay healthy, identify risks and stop illness. Preventive care includes child and adult screenings for a wide range of services, including immunizations and yearly exams.
Also known as a “living will”, this legal document notifies your doctor what kind of care you want/don’t want.
The limit to which your health plan will pay. This amount is in addition to your plan’s required copays and deductibles.
Care a person receives in a clinic, ER, hospital or surgery center without an overnight stay. Also known as “outpatient”.
This is the percentage of health care costs you pay after meeting your deductible—but before reaching your out-of-pocket maximum
A copayment or copay is a fixed payment for a covered service—like doctor visits, prescription drugs and other health care services—that you pay when you receive the service.
You’re responsible for paying for 100 percent of your care until you reach this amount, called the deductible. After that, your plan will pay a percentage of the cost if you stay in network.
A person who is covered by another’s plan. It can include a spouse or, child
Term that is used to decide who can receive coverage. Requirements can include, time of employment or job status
A formulary is a list of generic, brand-name and specialty drugs identified as providing the greatest overall effectiveness and value.
A participating provider who has agreed to accept the Allowed Amount as payment in full for covered services rendered after applicable co-payment/co-insurance. The member is not liable for any amount charged over the Allowed Amount.
In a given year, this is the most you'll pay for health care. . It includes money you've paid for deductibles, coinsurance and copayment—but it doesn't include your premiums.