Blue Cross Blue Shield PPO Network: refers to providers who are in-network within Unity’s Health Plans.
Co-insurance: the percentage of a bill you must pay for services once you have met the deductible (co-insurance applies only to those services that require a deductible and co-insurance, rather than a simple co-pay.)
Contingent Beneficiary: the person or people who receive pay-out from an insurance policy if no primary beneficiary is alive. Under Unity’s Life Insurance Plans, you may elect as many contingent beneficiaries as you like, designating what percentage of the total pay-out each would receive. If you opt for AD&D Insurance, it will automatically be assigned to the same contingent beneficiary(ies).
Co-pay: a flat amount you pay for a medical service or prescription. When a co-pay is required, you are not required to pay a deductible or co-insurance.
Deductible: the annual amount you must pay out-of-pocket (non-co-pay) for services before the plan begins to pay benefits. The deductible only applies to services for which you are required to pay co-insurance.
Dental Plan Lock-In Period: unlike with other benefits, once you enroll in dental coverage you are “locked in” to your choice for two enrollment periods and can’t make a change until the third enrollment period after you enroll. (You can add or cancel coverage during this time if you have a qualifying event, but you can’t change plans under any circumstances.) Note that if you elect not to enroll in dental coverage during one enrollment period, you can enroll the following year during Open Enrollment—there is not a two-year “lock-out” period.
In-network: refers to doctors, dentists, and other health care providers or facilities that participate in the health care, dental or vision plan. Most health care providers in our region (and the country) are in-network for Blue Cross Blue Shield, our insurance carrier. Dental and vision providers are more variable; before you make an appointment, it’s always best to check with the provider or the insurance company to see if the provider is in-network.
Medical Services Discount: the discount you and your eligible dependents receive when you use a Unity-employed doctor, service or facility.
Out-of-network: refers to doctors, dentists, and other health care providers or facilities that do not participate in the health care, dental or vision plans. When you visit an out-of-network medical doctor, you’ll generally have to meet a deductible and pay co-insurance, even if you are on the Unity Enhanced Health Plan. There are very few out-of-network medical care providers in our region. When you use an out-of-network dental or vision provider, the insurance company will reimburse you for a portion of the cost, but you will receive less reimbursement than you would for an in-network provider.
Out-of-Pocket Maximum: applies only to plans that involve a deductible and co-insurance. This is the cap on the amount you or your family are expected to pay for medical services out-of-pocket each year. Deductibles and co-insurance count toward your out-of-pocket maximum; co-pays do not. Each year, once you have reached your out-of-pocket maximum (either as an individual or as a family) any remaining medical costs (other than co-pays) are covered 100%.
Premium: the amount you pay toward the cost of a benefit. Premiums are deducted from your bi-monthly pay automatically. In some cases this deduction is taken from your pre-tax income, lowering the amount you pay in taxes.
Primary Beneficiary: the person or people you designate to be first in line to receive the pay-out from an insurance policy. Under Unity’s Life Insurance Plans, you may elect as many primary beneficiaries as you like, designating what percentage of the total pay-out each would receive. If you opt for AD&D Insurance, you will automatically be assigned the same primary beneficiary(ies).
Qualifying Event: change in job status or personal circumstances that legally qualifies you to make changes to your benefits in the middle of a plan year. Depending on the benefit, qualifying events might include (but not be limited to): marriage, divorce or legal separation, the birth or adoption of a child, the death of a dependent or the loss of benefits coverage from another source. Job status changes, such as a move from full to part-time work, are also technically qualifying events.
3-Tier Prescription Drug Benefit: classification system by which prescription drugs are assigned one of three levels (or tiers); the amount of your co-pay depends on the particular drug’s tier. Generally, the lowest co-pay is for generic drugs and the two higher co-pays are for name-brand drugs that the insurance company categorizes according to their original cost, perceived value and other such factors.