Requires payment of a percentage of the cost of the medical services. Most plans require either a coinsurance or copay: usually not both.
A flat fee charged each time you visit the doctor or use certain medical services regardless of the cost of the procedure. Doctor visits and pharmaceutical purchases are often subject to copays.
A person who is covered by another person’s plan. It can be a child, spouse or domestic partner.
Any employee working or residing outside of their home country. E.g. An American working in Italy.
Explanation of Benefits (EOB)
A detailed document provided by an insurance carrier outlining the charges, payments and balances of processed claims.
Health Savings Account (HSA)
An account that can be used to pay for covered health care costs or can be saved for future health care costs. Plan members must be covered by a high deductible health plan to qualify for an HSA.
High-Deductible Health Plan (HDHP)
A plan that meets Federal regulations and has a higher deductible than standard health plans allowing participants to utilize a health savings account (HSA).
Out-of-pocket maximum mandate
All cost sharing must apply toward the out-of-pocket maximum including in-network medical, behavioral health and pharmacy cost sharing. Does not include premiums, balance billing amount of non-network providers or spending for non-covered services. The out-of-pocket maximum must include copays, deductibles, and coinsurance.
Over-the-counter drugs (OTC)
Drugs that can be purchased without a prescription and are not covered under the Rx benefits of the plan.
The amount you pay for your insurance policy. Premiums are often deducted from your paycheck.
Preventive or Preventative Care
Services that can help prevent certain diseases and illnesses. Generally includes annual exams, immunizations and testing for certain diseases.
The common symbol describing prescription or pharmacy.
A provider that is trained in a specific medical area such as a dermatologist or cardiologist.Step TherapyA provision requiring members to try certain drugs prior to a particular brand name drug being paid for under the plan.
A provision requiring members to try certain drugs prior to a particular brand name drug being paid for under the plan.
Third Country National (TCN)
A foreign citizen of working in a country that is not his/her place of residence for a company that is headquartered in another foreign country. E.g. A French citizen working in Brazil for a company headquartered in Japan.
U.S. Bound Expat (Inpat)
A citizen of a foreign country working in the U.S.
U.S. Employee working for a non-US based Company
A U.S. citizen working for a foreign-owned company.