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Special Medical Plan Features
Nurse Care Manager–
Available 24/7, care coordinators can provide
information to help you make more informed health care decisions.
Call any time when you want to learn more about a recent diagnosis,
a minor sickness or injury, men's, women's, and children's wellness,
how to take Prescription Drugs safely, self-care tips and treatment
options, healthy living habits, or any other health related topic.
NurseLine is available to you at no cost.
Call: 1-800-459-2110 ext 2132
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Key Benefit Terms
COBRA
A Federal law that allows workers and dependents who lose their
medical, dental or medical flexible-spending account coverage to
continue any of these benefits for a specified length of time by electing
and paying for continuation benefits.
Coinsurance
Coinsurance is the percentage of Eligible Expenses that you are
responsible for paying. Coinsurance is a fixed percentage that applies
to certain Covered Health Services after you meet the Annual
Deductible.
Copayment (Copay)
A Copayment (Copay) is the amount you pay each time you receive
certain Covered Health Services. The Copay is a flat dollar amount
and is paid at the time of service or when billed by the provider.
Copays do not count toward the Annual Deductible. If the Eligible
Expense is less than the Copay, you are only responsible for paying
the Eligible Expense and not the Copay.
Annual Deductible
The Annual Deductible is the amount of eligible expenses you must
pay each calendar year for Covered Health Services before you are
eligible to begin receiving Benefits. The amounts you pay toward your
Annual Deductible accumulate over the course of the calendar year.
Amounts paid toward the Annual Deductible for Covered Health
Services that are subject to a visit or day limit will also be calculated
against that maximum benefit limit. As a result, the limited benefit will
be reduced by the number of days or visits you used toward meeting
the Annual Deductible.
Out-of-Pocket Maximum
The annual Out-of-Pocket Maximum is the most you pay each
calendar year for Covered Health Services. If your eligible out-of-
pocket expenses in a calendar year exceed the annual maximum, the
Plan pays 100% of Eligible Expenses for Covered Health Services
through the end of the calendar year.
Expenses incurred for the following are not be applied toward the
Out-of-Pocket Maximum:
- Premiums;
- Any charges that exceed eligible expenses;
- Any charges for non-covered health services.
Medical Insurance
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