Health Care Benefits Brochure - Pension Fund

Terms to KnowCoinsurance: The percentage of eligible expensesyou and the plan share. The exact coinsurancedepends on the plan your employer offers.Co-payment: The fixed, up-front dollaramount you pay for certain covered expenses.Co-payment amounts do not apply toward yourdeductible or coinsurance, and they do notaccumulate toward the out-of-pocket maximum.Deductible: Initial amount you must pay eachbenefit year for covered services before the planbegins to provide benefits.Flexible Savings Account (FSA): An accountallowed under Section 125 of the tax codeto allow employees to set aside funds on apre-tax basis to reimburse the member for IRSapproved medical, dental and vision expensesnot covered by Churchwide Healthcare. Thecatch is the “use it or lose it” clause, whichmeans if you do not exhaust your account in thecalendar year, then remaining funds remitto Churchwide Healthcare.High Deductible Health Plan (HDHP): A highdeductible health plan is defined as a healthplan that does not have deductible less than$1,200 for an individual/$2,400 for a family (not toexceed $6,050 individual/$12,100 for family). Maybe used with either a Health ReimbursementAccount or Health Savings Account for approvednon-covered medical expenses.Health Insurance Portability andAccessibility Act (HIPAA): This law has twoeffects on Churchwide Healthcare. On onehand, it mandates the issuance of certificatesof credible coverage to help offset pre-existingcondition time periods. More recently, it hasbeen updated to protect personal healthinformation (PHI) from being distributed todisinterested parties and to ensure the privacy ofour members.Health Maintenance Organization (HMO):This is a broad term encompassing a varietyof health care delivery systems utilizing grouppractice and providing alternatives to the feefor-serviceprivate practice of medicine andallied health professions.Health Reimbursement Account (HRA):Health Reimbursement Accounts are set upby employers to reimburse employees for IRSapproved medical, dental and vision expensesnot covered by Churchwide Healthcare, usuallypaired with the high deductible health plan.Health Savings Account (HSA): HealthSavings Accounts are money market likeaccounts that can be set up with contributionsfrom the employer, employee or both. Funds gointo these accounts tax-free and as long as thefunds are used for IRS approved medical, dentaland vision expenses not covered by ChurchwideHealthcare high deductible health plans, theycan be withdrawn tax-free. Funds are owned bythe employee, regardless of the contributor, andcan be carried over year to year.In-Network Care: Care you receive fromin-network physicians, specialists, hospitals,rehabilitation centers, labs and other healthcare providers that have signed an agreementwith their local Blue Cross and Blue Shield plan.In-network providers accept the allowablecharge as payment in full. They also file claimsfor you. In-network care is paid at the higherlevel of benefits.Out-of-Network Care: Care you receivefrom health care providers who are not in thenetwork. This care is covered at the lower, outof-networklevel when it is determined to bemedically necessary and appropriate.Out-of-Pocket Maximum: The amount youpay out of your pocket for eligible health careexpenses before the plan begins to pay 100% foradditional eligible expenses. The out-of-pocketlimit does not include co-payments, deductibles,mental health/substance abuse expenses,prescription drug expenses or amounts over theallowable plan charge.Preferred Provider Organization Program(PPO): A program that does not require theselection of a primary care physician, but isbased on a provider network made up ofphysicians, specialists, hospitals and otherhealth care facilities. Using this provider networkhelps assure members receive coverage foreligible services.Patient Protection and Affordable CareAct of 2010 (PPACA): Commonly known as theHealth Care Reform Law, this law is the guidingforce of health coverage starting 2011 goingforward. Some of the changes already in placeinclude covering dependents to age 26, no preexistingcondition clauses for children under age19, and codifying preventive care services to becovered at 100%.