Glossary

Aggregate Deductible

The entire family deductible amount must be met before benefits are available. Family members may combine their covered expenses to satisfy the family amount.

Coinsurance

The amount or percentage that you pay for certain covered services under the plan. This is typically the amount paid after a deductible is met.

Copayment (Copay)

A flat fee that you pay toward the cost of covered services.

Deductible

Before benefits are available, you must pay a specific dollar amount out of pocket. Under some plans, the deductible is waived for certain services. Unless otherwise noted, copays and charges for Non-covered Services or amounts in excess of the Allowable Charge do not count toward your deductible.

In-Network

A provider or facility who has contracted to provide services as part of a network. Find a Doctor

Out-of-Network

A provider or facility who has NOT contracted to provide services as part of a network.

Out-of-Pocket Maximum (OPM)

The maximum amount paid for covered services during a benefit period. The deductible, coinsurance and copayments apply towards meeting the OPM.

Primary Care Physician

A physician who has a majority of his or her practice in the fields of internal or general medicine, obstetrics/gynecology, general pediatrics, or family practice.

Specialist

A physician who has a majority of his or her practice in a field other than internal or general medicine, obstetrics/gynecology, general pediatrics, or family practice.

Urgent Care Facility

A facility, other than a hospital, that provides covered health services that are required to prevent serious deterioration of your health, and that are required as a result of an unforeseen sickness, injury or the onset of acute or severe symptoms.