2019 Benefits

Important Keyterms

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Although the premium is a pre-tax statement, Dwellworks covers the majority for each plan.

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A premium is the amount paid by the associate on a semi- monthly basis . PREMIUM

OUT-OF-POCKET MAXIMUM

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Examples of a co-pay include office visits, Rx, urgent care, emergency room, and other services outlined in the summary of benefits and summary plan descriptions. Although a co-pay is excluded from the deductible, it is included in the out-of-pocket maximum. For a deductible, apply only to covered medical services listed with a percentage in the summary of benefits and summary plan descriptions. On the PPO plans, the single deductible applies to each individual enrolled in the EE+children or family plans with no more than three family members maxing out the deductible. The coinsurance eligible services are noted in the summary of benefits with notation of a percentage, and the costs will be applied to deductible. Once the deductible is satisfied, the associate will share in the service’s cost.

The out-of-pocket maximum is the amount an associate will pay annually for services.

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CO-PAY

COINSURANCE

A co-pay is a flat dollar amount paid for services as part of the Preferred Provider Organization (PPO) plans.

A coinsurance is the percentage of negotiated costs that associates pay for eligible services.

A deductible is the annual amount that must be satisfied prior to coinsurance percentages being applied. DEDUCTIBLE

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Services for out-of-pocket maximum apply to co-pays, deductibles and coinsurances.