Benefits 101

The amount you pay for your benefits coverage. Your portion of the premium is generally deducted from your paycheck.

The amount you pay for covered services before your plan begins sharing the cost. Some services may be covered before you meet your deductible.

A fixed amount you pay for a covered service, such as a doctor’s visit or prescription. The amount may vary depending on the service.

The percentage of the cost you pay for a covered service after meeting your deductible. Your plan pays the remaining covered percentage.

The most you will pay for covered, in-network services during a plan year. After you reach this amount, the plan generally pays 100% of additional covered, in-network expenses for the remainder of the plan year. Premiums and non-covered services generally do not count toward this maximum.

A doctor, facility, or other health care provider that has contracted with your plan. Using in-network providers generally helps you pay less for care.

A provider that does not participate in your plan’s network. Care received out of network may cost more or may not be covered, depending on your plan.

Routine care intended to help prevent or detect health concerns, such as annual physicals, certain screenings, and immunizations. Eligible preventive care is generally covered at 100% when you use an in-network provider.

Approval that may be required from your insurance carrier before you receive certain services, procedures, or medications. Prior authorization does not guarantee that a service will be covered.

A statement from your insurance carrier explaining how a claim was processed. It shows what the provider charged, what the plan paid, and what you may owe. An EOB is not a bill.

A tax-advantaged account available to employees enrolled in an eligible high-deductible health plan. HSA funds can be used for eligible health care expenses and generally remain in your account from year to year.

A tax-advantaged account that allows you to set aside money from your paycheck to pay for eligible expenses. Different types of FSAs may cover health care or dependent care expenses. Rules and deadlines apply to the use of FSA funds.

In most cases, you can elect or change your benefits when you are first eligible or during Open Enrollment. You may also be able to make certain changes during the year if you experience a qualifying life event and submit your requested change within the required timeframe.

Visit the Life Events page for additional information.