Means your share of the cost for covered services that is a percentage of the Maximum Allowed Amount that you must pay. You pay the Co-insurance after you meet your Deductible.
Example: Your plan has a 20% Co-insurance on an office visit amount of $100. In this case, your Co-insurance Cost-Share of the Maximum Allowed Amount would be $20, after you have met your Deductible. The plan would then cover the remaining 80% of the Maximum Allowed Amount, or $80.
Means a fixed-dollar amount that is your share of the cost for certain Covered Services. Co-payments do not apply to the Deductible but do apply to the Maximum Out-of-Pocket. Only the LivingWell PPO plan utilizes Co-payments.
Means that portion of payment for Covered Services that is your responsibility. Depending on the plan you choose, Cost-Share includes your Deductible, Co-payments, and Co-insurance. Your Cost-Share may vary depending on whether you receive Covered Services from a Network or an Out-of-Network Provider.
Means medically necessary medical care and prescription drugs that are covered under your health plan. Please see the Medical Benefit Booklet and Summary Plan Description for your plan, for more information.
Means the amount you must pay for Covered Services before your plan will begin to pay. After you have met your plan's Deductible, you will only be responsible for your Co-insurance and any applicable Co-payment. Some Covered Services, such as preventive care, will be covered by your plan at 100%, without regard to the Deductible.
Means a list of prescription drugs covered by a plan offering prescription drug benefits.
Means the maximum dollar amount that the plan will pay for Covered Services provided by a Network or Out-of-Network Provider. The Maximum Allowed Amount may be established by a contract between Anthem or CVS Caremark with a Network Provider or by the plan's coverage rules as outlined in the Medical Benefit Booklets or the Summary Plan Descriptions.
Means the maximum amount that you will pay out of pocket for Covered Services under your plan during a given calendar year. When the Maximum Out-of-Pocket is reached, the plan will pay 100% of the Maximum Allowed Amount for Covered Services, and you are no longer responsible for any Cost-Share.
reached, the plan will pay 100% of the Maximum Allowed Amount for Covered Services, and you are no longer responsible for any Cost-Share.
Means the document that lists the Covered Services for each plan offered by the KEHP as well as the rights and responsibilities of members of the health plan, including but not limited to Deductibles, Co-insurance, Co-payments, preauthorization requirements, coverage exclusions, and claim denial appeal procedures.
Means a physician, health professional, hospital, pharmacy, or other individual, organization, and/or facility that has entered into a contract, either directly or indirectly, with Anthem or Caremark, to provide Covered Services through negotiated reimbursement arrangements.
Means a physician, health professional, hospital, pharmacy, or other health care provider that has not entered into a contract, either directly or indirectly, with Anthem or CVS Caremark, to provide Covered Services at the time such Covered Services are rendered.
Means a life event, such as marriage or birth of a child that, upon occurrence, will enable an employee to enroll in, change, or terminate health, life, dental, or vision insurance coverage outside the open enrollment period or the enrollment period for newly hired employees.
Means a questionnaire that documents the overall health of an employee or an employee's spouse who is seeking to increase their optional life insurance coverage limits. The Statement of Health, sometimes referred to as an Evidence of Insurability questionnaire, is a form provided by MetLife, and is used by MetLife to evaluate the life insurance application when you elect coverage at a time other than an applicable open enrollment or as a new hire.
Means the document that lists the prescription drugs covered under each plan offered by the KEHP as well as the rights and responsibilities of members of the health plan, including but not limited to Deductibles, Co-insurance, Co-payments, preauthorization requirements, coverage exclusions, and claim denial appeal procedures. A Summary Plan Description is also available for Health Flexible Spending Accounts, Child and Adult Daycare Flexible Spending Accounts, and Health Reimbursement Arrangements.