Health Care 101

They bill your insurance company directly at negotiated rates, saving you time and money. Make sure a service is covered by your insurance company before you receive care. Note: If you’re enrolling in an HMO plan (if available in your area), the plan only pays benefits for care received in network.

It’s fully covered by all of our medical plans and can help detect and prevent potentially costly health issues. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.

Contributing to a Flexible Spending Account (FSA) is easy and saves you money. You can set aside pre-tax dollars from your paycheck to use for your out-of-pocket costs. With an FSA, you can only carry over up to $660 of unused FSA money to the next year; you will forfeit amounts above $660. Please note that you must enroll in the FSA again during Open Enrollment in order to carry over the remaining amount.

Using generic alternatives will almost always save you money — and they’re just as effective as brand-name prescriptions. It’s also a good idea to compare prices at different pharmacies before deciding where to fill a prescription. For your ongoing prescriptions, use the home-delivery service to save money and time.

Log in to the UnitedHealthcare website or the Kaiser Permanente website to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.

A drug with a patent and a trademark name. This type of drug is usually more expensive than alternative generic drugs but cheaper than non-formulary drugs.

Your share of the cost for a covered service, calculated as a percent of the allowed amount of the service. You pay coinsurance plus any deductibles you owe.

A fixed amount (for example $15) you pay for a covered health care service, usually the day you receive the service. The amount can vary based on the type of service provided.

The amount you have to pay for covered services each year before your health plan begins to pay.

For example, if your annual deductible is $3,000, you must pay for your nonpreventive expenses until your costs reach $3,000, after which the plan will start to pay a percentage of costs.

Plans typically have different deductibles for individual coverage and family coverage. Depending on your plan, you might need to meet a separate deductible for each covered family member or one larger family deductible before coinsurance begins for anyone.

Your deductible does not apply to in-network preventive care, which is covered at no cost to you. Depending on your medical plan, the deductible may not apply to other services, too, such as doctor’s office visits and prescriptions.

A Dependent Care FSA allows you to pay for eligible dependent care expenses with tax-free dollars. Since you don’t pay income tax on money you put in an FSA, it’s like getting a discount on your child care or elder care costs! Eligible expenses for a Dependent Care FSA include day care and summer camps for children under age 13, and day care for dependent elders.

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. You can only use money actually deposited into your account.

Dependent Care FSAs have a “use it or lose it” rule, so typically, any unused money left in your account at year-end is forfeited.

A drug that offers equivalent uses, doses, strength, quality and performance as a brand‑name drug but is not trademarked. Because of this, generic drugs are typically your cheapest option when purchasing prescription drugs.

A Health Care FSA is an account you can use to pay for eligible health care expenses with tax-free dollars. Since you don’t pay income tax on the money you put in an FSA, it’s like getting a discount on your medical, dental, vision, and medication costs! Eligible expenses for a Health Care FSA include deductibles, coinsurance, and copays for medical, dental, and vision care, as well as many over-the-counter items like bandages, sunscreen, and feminine care products.

You contribute to your FSA through before-tax payroll deductions by selecting how much you want to contribute over the course of the plan year, with a proportionate amount of that annual contribution coming out of each paycheck. Your entire annual contribution to a Health Care FSA is available to you from the beginning of the plan year.

FSAs have a “use it or lose it” rule, so you may forfeit any unused money at the end of the year. Depending on your account rules, you may be able to carry over your balance up to a certain amount, or you may be offered an extension to the year-end deadline.

With these health plans, your coverage is limited to doctors and providers who work for or contract with the HMO, so out-of-network care is generally not covered except in an emergency. However, you can receive comprehensive care in-network that is coordinated by a Primary Care Physician. An HMO is a medical plan that provides coverage only when you receive care from providers within the HMO network. You’re required to select a primary care provider (PCP) who will coordinate your care to manage costs.

Generally, HMOs have a low or no deductible and low to moderate premium costs, with copays typically paid at the time of service for nonpreventive in-network medical care and prescriptions. Keep in mind that in-network preventive care, like annual physicals and immunizations, is covered in full at no cost to you.

You’re also protected by an annual limit on costs — if you reach the out-of-pocket maximum, the plan pays 100% of any further covered expenses for the rest of the year.

Mail order pharmacies generally provide a 90-day supply of a prescription medication for less than the cost of a 60-day supply at a retail pharmacy. Plus, mail order pharmacies offer the convenience of shipping directly to your door.

The maximum amount you and your family must pay for eligible expenses each plan year. Once your expenses reach the out-of-pocket maximum, the plan pays benefits at 100% of eligible expenses for the remainder of the year. Your annual deductible is included in your out-of-pocket maximum.

With these health plans, you can use any doctor, clinic, hospital or health care facility in the national network. Staying in the network — a group of health care providers and facilities that have a contract with UnitedHealthcare — saves you money.

Premiums are the money you contribute from your paycheck to pay your share of the cost of being enrolled in a health plan. Lineage also pays a large percentage of this cost.

Your premium depends on the plan you choose and who you enroll. For example, a medical plan with a low deductible will have a higher premium than a plan with a higher deductible. And, you’ll pay a lower premium to enroll yourself, while a higher premium would apply when enrolling your spouse and kids.

Preventive care services include routine physicals, health screenings, routine blood work, and recommended immunizations. In-network preventive care is covered free of charge with all plans.

An individual physician who oversees the team providing care for you and your family. They diagnose and treat a wide variety of acute and chronic health problems and connect you with appropriate services for routine and specialty care.

A Qualifying Life Event is a change in your life that qualifies you to update your benefits enrollment before the next Open Enrollment. For example, if you get married in April and your Open Enrollment is typically in the fall, you wouldn’t need to wait until then to change your benefits. You could add your spouse to your coverage or drop your coverage and join your spouse’s plan within 31 days of your wedding. Only changes related to your life event are allowed.

A specialty drug is generally a high-cost, self-administered biotechnology drug used to treat certain illnesses. OptumRx Specialty Pharmacy (for UHC members) or Kaiser Permanente can provide resources and personalized support to help you if you need one of these drugs.

Prevailing market rates for services provided by health care professionals within a certain area for certain procedures. Reasonable & Customary rates may apply to out-of-network charges.

Teladoc provides convenient, 24/7/365 access to board-certified doctors by phone or video, wherever you are. These appointments are typically less expensive than going to an urgent care center, with costs varying depending on your medical plan. In some cases, certain specialist visits are available through telehealth, such as psychiatry and dermatology.