Glossary
Benefit lingo can be confusing. Below you will find the most commonly used medical terms.
Copay
A fixed dollar amount you pay at the time of service.
Deductible
The amount you pay for covered services before the medical plan begins to pay its share for services. A new annual deductible applies each calendar year. The annual deductible is not prorated for new hires.
Coinsurance
A form of cost-sharing in which you and the medical plan each pay a set percentage for covered provider services.
Summary of benefits and coverage
The benefits summary has more details about each benefit.
High Deductible Health Plan
This is a medical plan with a higher deductible than a traditional plan. A high deductible plan can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money free from federal taxes. Natus’ Aetna PPO with HSA is such a plan. For 2019, the IRS defines a high deductible health plan as any plan with a deductible of at least $1,400 for an individual or $2,800 for a family. An HDHP’s total annual out-of-pocket expenses (including deductibles, copayments, and coinsurance) can’t be more than $6,900 for an individual or $13,800 for a family. (This limit doesn’t apply to out-of-network services.) (This limit doesn’t apply to out-of-network services.)
Provider network
The facilities, providers and suppliers your medical plan carriers (Aetna, Kaiser, Dean Health Plan) have contracted with to provide health care services under discounted fees.
Out-Of-Pocket Maximum
The maximum amount of money you will have to pay in a calendar year for medical expenses. When you reach the out-of-pocket maximum, medical benefits for the rest of the year are paid by the plan at 100%. The out-of-pocket maximum is not prorated for new hires. After you reach the out-of-pocket maximum, you no longer pay coinsurance for the remainder of the calendar year. However, you remain responsible for dollar copays under the traditional PPO, and for non-PPO providers, costs that are in excess of the covered expense, as determined by Aetna.
An easy-to-understand summary of your coverage which is made available from your health insurance plan under the Affordable Care Act.
Benefits Summary