Here are some common terms that can help you understand your deductible plan.
The percentage of charges you pay when you receive certain covered services. For example, a 20 percent coinsurance on a $200 procedure means you’ll pay $40 for that procedure.
The set dollar amount you pay for certain covered services or prescriptions. For example, a $10 office visit copay means you'll pay $10 for each office visit.
The set amount you need to reach before you'll pay copays or coinsurance for most covered services for the rest of the plan year. Until you reach the deductible, you'll pay the full charges for most services.
A document that shows detailed information about your benefits and coverage. Your employer's human resources department should be able to provide you with a copy. If you have a direct-pay plan, the EOC is included with your plan welcome materials.
A summary of services received, including dates received and the provider's name. An EOB is not a bill, but it can help you keep track of your health care expenses.
An HRA allows you to use funds contributed by your employer to pay for qualified medical expenses. Because the money in your HRA isn't considered part of your wages, it's not subject to federal income taxes.
A financial account that you can fund with pretax* contributions from your paycheck, or after-tax contributions that are tax deductible. You can use funds in your HSA account to pay for qualified medical expenses now or in the future, even if you change jobs or retire.
These are services that diagnose a condition for which you have symptoms or that are used to treat a condition for which you’ve already been diagnosed. You may go in for a preventive care service and receive a non-preventive service during the same visit. While most preventive care services are available to you for little or no cost, you’ll probably pay more for any non-preventive service you receive. For example, your doctor might find a mole during a routine preventive exam and decide to remove it for testing. Because mole removal is considered non-preventive, you may have an additional copay, coinsurance, or deductible payment for this procedure.
The maximum amount you’ll pay in a calendar year for most services covered by your plan. After you reach this amount, we’ll provide most covered services at no cost to you for the rest of the calendar year.
Preventive care services are types of routine care intended to help keep you healthy. A service is considered preventive if you have no symptoms indicating that you’re in need of diagnostic services or treatment, and if no signs of illness are discovered during the service. Our deductible plans cover most preventive care services at little or no cost to you without having to meet your plan deductible.
If you have an HRA or HSA, you can use the funds in your account to pay for qualified medical expenses, as defined in Internal Revenue Code Section 213(d). For a list of qualified medical expenses, download a copy of IRS Publication 502, Medical and Dental Expenses at irs.gov/publications.
If you have an HRA and your employer offers the rollover option, you can use funds left over from one year to pay for qualified medical expenses the next year, as long as you’re still a member of the plan. How funds roll over — including how much can roll over from year to year — will depend on your plan details.
With an HRA, you may be asked to submit proper documentation to validate a claim, such as an Explanation of Benefits (EOB), bill, or receipt. Check with your HRA administrator for specific requirements.
*The tax references on this website relate to federal income tax only. Consult with your financial or tax adviser for information about state income tax laws. Federal and state tax laws and regulations are subject to change. If tax, investment, or legal advice is required, seek the services of a qualified professional.