Words To Know

Copay: The fixed dollar fee you are required to pay for certain covered health services, such as office visits. Copays do not apply toward your deductible or out-of-pocket maximum.

Coinsurance: The percentage of the total cost of services that you and Children’s share. For example, Children’s pays 85% of the cost of a generic prescription, and you are responsible for paying the remaining 15%. That 15% is your coinsurance amount.

Deductible: The amount you must pay for covered health services in a calendar year before the medical plan will begin paying for benefits during that calendar year.

Emergency: A life-threatening condition resulting from an injury or illness that arises suddenly and requires immediate treatment to avoid jeopardy to life or health (e.g., fracture, heart attack).

Healthcare Reimbursement Account (HRA): An account funded 100% by Children’s to help you meet your annual deductible if you enroll in Choice Saver. If you stay enrolled in Choice Saver, any remaining balance will roll over to the following year.

Network or In-Network Provider: A doctor, hospital, lab or other medical facility that has contracted with UnitedHealthcare. The provider agrees to accept a negotiated rate for services. You will always pay less out-of-pocket by using a network provider. The Choice Basic option covers only in-network providers.

Out-of-Pocket Maximum: The most you will pay out-of-pocket for deductibles and coinsurance in a calendar year. Once you pay this amount, the medical plan pays 100% coinsurance for covered medical expenses through the end of the calendar year. Copays will still be charged, even if the out-of-pocket maximum is met.