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Medical Terms Glossary Important Terms Insurance can sometimes sound like a foreign language.Take a moment to review the meaning of these common terms to best understand your benefit plans. Preventive and Non-Preventive Services Annual Deductible Preventive care services are those that are generally Your annual deductible is the amount of money you linked to routine wellness exams. Non-preventive must first pay out-of-pocketbefore your plan begins services are those that are considered treatment or paying for services covered by coinsurance. Some diagnosis for an illness, injury, or other medical services, such as office visits, require copays and do condition. There are limits on how often you can not apply to the deductible. This is an annual receive preventive care treatments and services. You calendar year deductible. should ask your health care provider whether your isit is considered preventive or non-preventive care. After you meet your deductible, the plan pays for a Examples of preventive care include: percentage of eligible expenses (coinsurance) until • Annual routine physicals you meet your out-of-pocket maximum. If you • Bone density tests,cholesterol screening receive services from an out-of-network provider, • Immunizations, mammograms, Paps smears, pelvic exams, PSA examsthe plan pays a lower percentage ofcoinsurance. • Sigmoidoscopies, colonoscopies Refer to your health care plan summaries for more information. Copayment and Coinsurance Out-of-Pocket Maximum copayment (copay) is the fixed dollar amount you Some plans feature an out-of-pocket maximum, pay for certain in network services. In some cases, which limits the amount of coinsurance you will pay ou may be responsible for coinsurance after a copay for eligible health care expenses within:a calendar is made. year. Once you reach that maximum, the plan begins Coinsurance is the percentage of covered expenses to pay 100% of eligible expenses. There may be shared by the employee and the plan. In some cases, separate in and out-of-network annual coinsurance is paid after the insured meets a out-of-pocket maximums. Copays, deductible and deductible. For example, if the plan pays 90% of an coinsurance accumulate towards your out-of-pocket in-network covered charge,you pay 10%. maximum. Care Coordination In-Network Advantage hen you need hospital care or have complex health Within some of the medical, dental and vision plans, care needs, Florida Blue's Care Coordinators are you have the freedom to use any provider. available to assist you and your family. From handling However, when you use an in-network provider, the benefit and approvals, to scheduling follow up care percentage you pay out-of-pocket will be based on a and connecting you with health programs and negotiated fee, which is usually lower than the resources, you'll have extra help so you can focus on actual charges. If you use a provider who is outside :etting well and staying well. Call Florida Blue at of the network, you may be responsible to pay for 888-476-2227. the difference of the Usual, Customary and Reasonable (UCR) charges and what the provider NURSES ON CALL 24/7: bills. You also may need to submit claim forms. hen you need answers right away,call a nurse 24/7. hether you or your family members have health concerns or general health questions, the nurseline is available at no cost.Simply call 877-789-2583. 51 16