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In the dark about health care terminology? We'll turn on a light. Following are a few terms often found in our plan descriptions. For more detailed questions on plan coverage, visit our FAQs section or call Member Services at 800-883-2177.
Out-of-pocket
Your health care plan will cover a certain percentage of the service costs depending on what plan you have and what service you have done. The remaining amount that is not covered by your plan is what you pay – your out-of-pocket expense.
Preferred Provider Organization (PPO)
HealthPartners has chosen certain preferred hospitals and health care providers to be included in our network. We've identified what we feel are some of the best, most trusted medical facilities. Together, they make up our Preferred Provider Organization (PPO).
Premium
A premium (usually expressed in a monthly rate) is the amount you pay HealthPartners for your health care coverage.
Preventive Care
Preventive care includes routine checkups and procedures for maintaining your health. Preventive care should be performed on a regular basis – its goal is to prevent health problems from arising and keep you in top-notch condition.
Primary Care Clinic
Your primary care clinic is where you go to receive all of your general medical care, including things such as routine checkups. At your primary care clinic, you will visit with your family physician. If necessary, he/she will refer to you to a specialist.
Provider
A provider is any medical care facility or hospital that provides you with health care services. The HealthPartners nationwide network includes more than 650,000 providers that are ready to serve you with quality care.
Referral
In order to see certain care providers or specialists, you may need a referral. A referral comes from your primary care or general medical doctor and is his or her way of directing you to someone in a more specialized area that is an expert on your condition and can better help you.
Specialist
A specialist is a care provider who has a niche in a certain area of medicine, such as a dermatologist, who handles skin conditions. Your primary care doctor will assess whether or not you need to see a specialist for your condition and give you a referral accordingly.
Summary of Benefits (SOB)
A Summary Of Benefits (SOB) is a document that provides an overview of what is covered in your health care plan. It shows what specific procedures are covered and amounts for deductibles, copays and more.
Tiering
Tiering is a form of ranking health care providers based on quality and cost. With HealthPartners tiered plans, providers are divided into different benefit tiers based on the cost and quality of their services. You pay a lower cost when you go to providers in Tier 1, which have the highest quality and lowest total cost of care. |
Copay
A copay (or copayment) is the amount you will pay for medical services. It is usually a flat sum amount such as $10 for each doctor visit ($10 copay). Copay is different from coinsurance, which is based on a percentage of the cost.
Coinsurance
Coinsurance is the portion or percentage of the service costs that you are responsible for paying. It is expressed as a percentage, not a flat sum amount like a copay.
Deductible
A deductible is the amount you are required to pay before benefits become available. It is usually expressed in terms of an "annual" amount.
Explanation of Benefits (EOB)
An Explanation Of Benefits (EOB) is a document you receive after you have had services or procedures performed. It explains what costs of the procedure are covered by HealthPartners, and what costs you as the patient are responsible for paying.
Flexible Spending Account (FSA)
A flexible spending account (FSA) is designed to give you more options with your health care plan. It allows you to create an account where you set aside money for health care expenses and use it tax-free.
Health Reimbursement Account (HRA)
A health reimbursement account (HRA) is an account your employer establishes to help you pay for your medical expenses. The HRA helps you pay your deductible for the plan. You pay up to the deductible, and then your plan coverage kicks in.
Health Savings Account (HSA)
A health savings account (HSA) is similar to a regular savings account. You establish the HSA with a bank or other financial institution and save money in the account to use for your health care expenses. Contributions you make to your HSA are taken from your pay before income taxes are withheld, so your taxable income is reduced! The money you use from the account is not taxed as long as it is used for eligible medical expenses. High Deductible Health Plan (HDHP)
A high-deductible health plan (HDHP) features lower premiums and higher annual deductibles than traditional health care plans. It is usually associated with flexible spending accounts and health savings accounts.
In-network
In-network refers to physicians, hospitals and other providers who are a part of our designated HealthPartners network. By going to these preferred in-network providers for care, you generally receive better care at a lower cost.
Out-of-network
Out-of-network refers to physicians, hospitals and other providers who are not part of our designated HealthPartners network. You can still elect to go to these non-network providers, but you generally will pay more for services.
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