10-12-2022 PTL - Flipbook - Page 30
30 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, October 12, 2022
Health glossary, continued
from previous page
usually funded through voluntary salary
reduction agreements with your employer.
No employment or federal income taxes
are deducted from your contribution. The
employer may also contribute.
Formulary
A list of prescription drugs covered
by a prescription drug plan or another
insurance plan offering prescription drug
benefits. Also called a drug list.
Gold Health Plan
One of 4 health plan categories, or
metal levels, in the health insurance marketplace. Gold plans usually have higher
monthly premiums, but lower costs when
you get care. Gold may be a good choice
if you use a lot of medical services or
would rather pay more up front and know
that you’ll pay less when you get care.
Health Insurance Marketplace
The Health Insurance Marketplace is
available to residents of states working
directly with the federal government to
operate health insurance exchanges.
Health Maintenance Organization
An HMO is a type of health insurance
plan that usually limits coverage to care
from doctors who work for or contract
with the HMO. An HMO generally won’t
cover or has limited coverage for out-ofnetwork care, except in an emergency.
HMO members usually have a primary
care doctor and must get referrals to
see specialists. HMOs often provide integrated care and focus on prevention and
wellness. In general, HMO plans are the
least expensive plans that health insurance companies offer.
Health Savings Account (HSA)-Eligible Plan
A type of health plan with specific costsharing rules on how they cover benefits.
For the most part, except for zero-cost
preventive care and prescription drugs,
HSA-eligible plans have cost-sharing that
begins paying for care only after you have
met your deductible. Also, all HSA-eligible
plans must have a deductible high enough
to be considered a High-Deductible
Health Plan (HDHP). Because of these
costs, HSA-eligible plans have some of
the lowest premiums on Maryland Health
Connection. An advantage of enrolling in
an HSA-eligible plan is the ability to open
a Health Savings Account from an HSAsponsoring entity (many banks, and other
financial entities offer HSA services) and
begin saving money tax-free to spend on
certain health-related products (like eyeglasses) and services (like doctor visits).
HSA funds cannot be used to pay for
premiums. In addition, money that you
deposit into your HSA can be deducted
on your taxes. Also, when you open an
HSA, it can stay with you for life, even
if you later receive coverage through an
employer or are covered with a non-HSA
eligible plan. The IRS has established
rules on managing your HSA funds when
you are not enrolled in an HSA-eligible
plan.
Hospital Outpatient Care
Care in a hospital that usually doesn’t
require an overnight stay.
In-network Coinsurance
The percent (for example, 20%) you
pay of the allowed amount for covered
health care services to providers who
contract with your health insurance or
plan. In-network co-insurance usually
costs you less than out-of-network coinsurance.
In-network Copayment
A fixed amount (for example, $15) you
pay for covered health care services to
providers who contract with your health
insurance or plan. In-network copayments
usually are less than out-of-network
copayments.
Maryland Children’s Health Program
(MCHP)
A program that provides medical coverage for qualifying uninsured children
under the age of 19. Uninsured children
from households with higher income levels may qualify for MCHP Premium.
Medicaid
A federal-state program that provides
free health coverage for eligible lowincome children up to age 21 and adults,
as well as pregnant women who qualify.
Metal Level
There are several categories of insurance plans: metal levels called Bronze,
Silver, Gold and Platinum, as well as
Catastrophic plans. Plans in these categories differ based on how you and the
plan share the costs of your care.
Out-of-network Copayment
A fixed amount (for example, $30) you
pay for covered health care services from
providers who don’t contract with your
health insurance or plan. Out-of-network
copayments usually are more than innetwork copayments.
Navigator
Navigators deliver in-person outreach,
education, and enrollment in health plans
and public insurance options. Consumers
can get one-on-one assistance from our
statewide network of navigators.
Out-of-pocket Maximum
The most you pay during a policy period (usually one year) before your health
insurance or plan starts to pay 100% for
covered essential health benefits. The outof-pocket maximum includes the yearly
deductible and may also include any cost
sharing you have after the deductible.
Network (also referred to as in-network)
The facilities, providers and suppliers
your health insurer or plan has contracted
with to provide health care services.
Non-Preferred Provider
A provider who doesn’t have a contract with your health insurer or plan to
provide services to you. You’ll pay more
to see a non-preferred provider. Check
your policy to see if you can go to all
providers who have contracted with your
health insurance or plan, or if your health
insurance or plan has a tiered network
that requires you to pay extra to see some
providers.
Open Enrollment
A designated period of time each year
during which individuals or employees can
enroll in a health insurance plan or make
changes to their coverage. Maryland open
enrollment is Nov. 1-Dec.15.
Out-of-network
A provider who doesn’t have a contract with your health insurer or plan to
provide services to you. You’ll pay more
to use them.
Out-of-network Coinsurance
The percent (for example, 40%) you
pay of the allowed amount for covered
health care services to providers who
don’t contract with your health insurance
or plan. Out-of-network co-insurance
usually costs you more than in-network
co-insurance.
Preauthorization
A decision by your health insurer or
plan that a health care service, treatment
plan, prescription drug or durable medical equipment is medically necessary.
Sometimes called prior authorization,
prior approval or precertification. Your
health insurance or plan may require preauthorization for certain services before
you receive them, except in an emergency. Preauthorization isn’t a promise
your health insurance or plan will cover
the cost.
Premium
The periodic payment to an insurance
company or a health care plan for health
or prescription drug coverage.
Preventive Services
Routine health care that includes
screenings, check-ups, and patient counseling to prevent illnesses, disease, or
other health problems or to detect illness
at an early stage, when treatment is likely
to work best (this can include services like
flu and pneumonia shots, vaccines, and
screenings like mammograms, depression/behavioral health screenings, or
blood pressure tests, depending on what
is recommended for you).
Primary Care Provider
The doctor you see first for most
health problems. He or she makes sure
you get the care you need to keep you
Health glossary,
continued on next page