Find helpful resources, forms and plan information below.
Glossary of Terms
Use these definitions of common terms to help you navigate your benefits options.
The amount of percentage that you pay for certain covered health care services under your health plan. This is typically the amount paid after a deductible is met, and can vary based on the plan design.
A flat fee that you pay toward the cost of covered medical services.
A specific dollar amount you pay out-of-pocket before benefits are available through a health plan. Under some plans, the deductible is waived for certain services.
Individuals who meet eligibility requirements under a health plan and are enrolled in the plan as a qualified dependent.
Health care received from your primary care physician or from a specialist within an outlined list of health care practitioners.
You and those covered become members when you enroll in a health plan. This includes eligible employees, their dependents, COBRA beneficiaries and surviving spouses.
Health care you receive without a physician referral, or services received by a non-network service provider. Out-of-Network health care and plan payments are subject to deductibles and co-payments.
Amount that you must pay toward the cost of health care services. This includes deductibles, copayments and coinsurance.
Out-Of-Pocket Maximum (OOPM)
The highest out-of-pocket amount paid for covered services during a benefit period.
The amount you pay for a health plan in exchange for coverage. Health plans with higher deductibles typically have lower premiums.
Primary Care Physician (PCP)
A doctor who is selected to coordinate treatment under your health plan. This generally includes family practice physicians, general practitioners, internists, pediatricians, etc.
Usual, Customary and Reasonable (UCR) Allowance
The fee paid for covered services that is: (1) a similar amount to the fee charged from a health care provider to the majority of patients for the same procedure; (2) the customary fee paid to providers with similar training and expertise in a similar geographic area, and (3) reasonable in light of any unusual clinical circumstances.