ANNUAL DEDUCTIBLE
Amount you will pay in one plan year before coverage begins. Out-of-network charges in Minnesota do not apply to the annual out-of-pocket maximum.
ANNUAL OUT-OF-POCKET MAXIMUM
The most you could pay in one plan year for covered medical services and supplies.
INITIAL COVERAGE STAGE
During the initial coverage stage after any deductible has been met, the plan pays its share of the cost of your covered prescription drugs and you pay your share (either a copay or coinsurance).
COVERAGE GAP STAGE
You may have to pay a different amount after your total yearly retail costs reach $4,430 for covered prescription drugs. This includes both prescription drugs equal to the amount you have paid plus what the plan has paid for the calendar year, not including premiums.
CATASTROPHIC COVERAGE STAGE
If you reach this stage, your plan will cover most of the costs of your covered drugs for the rest of the year. This happens if your total out of pocket costs for prescription drugs reaches $7,050, not including premiums.
COINSURANCE
An amount — usually a percentage — you might be required to pay as your share of the cost for services after you pay any deductibles.
COPAY (COPAYMENT)
A fixed amount you might be required to pay as your share of the cost for a medical service or supply, such as a doctor’s visit, hospital outpatient visit, or prescription drug.
EVIDENCE OF COVERAGE (EOC)
A document that describes the health care benefits covered by your health plan.
EXPLANATION OF BENEFITS (EOB)
The statement you receive after using your health plan benefits. It is not a bill, but shows an itemized list of what your plan paid and the amount you owe.
GROUP NUMBER
The number on your member ID card assigned by your health plan. You will need this number when registering for your online member account.
MEDICAID
A joint federal and state program that helps with medical costs for some people with limited income and resources. Most health care costs are covered if you qualify for both Medicare and Medicaid, but Medicaid programs vary from state to state.
PART A
Part A is the part of Original Medicare that provides inpatient hospital coverage and benefits, including hospice and home health services.
PART B
Part B is the part of Original Medicare that provides coverage and benefits for outpatient and preventive care, and other services.
PART C
Part C is offered through a private insurance company, combining Part A and Part B and sometimes Part D.
PART D
Also called Prescription Drug Plan, Part D provides prescription drug coverage and can be purchased as a standalone plan or part of a Medicare Plan.
PREMIUM
Your monthly payment for a plan.
PRESCRIPTION DRUG FORMULARY
A list of drugs covered by the plan. Formularies are approved by the federal government and have different tiers of drugs that are covered.
PRIOR AUTHORIZATION
For certain procedures or prescriptions, your insurer needs to be aware beforehand to ensure you are getting the proper care and that it will be covered under your plan.
PROVIDER NETWORK
Recommended health care providers that are part of your plan, and will be less expensive for you to see. Seeing a health care provider outside your provider network will be more expensive and possibly not covered by your insurance.
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