A condition that is not ongoing, like pink eye or the common cold.
A condition that is ongoing, like diabetes or asthma.
Walk-in clinics that are usually found in retail stores, grocery stores and pharmacies. Convenience clinics provide care for a limited list of simple conditions and usually charge a set fee. No appointment is needed.
A way to get a diagnosis and treatment online. Based on the information you provide, a licensed medical professional will look at your symptoms, and give you a personal diagnosis and treatment plan.
Services you get in an emergency room for serious or life-threatening illnesses or injuries.
Care in a hospital when you stay overnight.
Care in any health care setting that doesn't require an overnight stay.
Clinic for urgent needs, often open at night and on weekends.
Any family member, or combination of family members, needs to meet the deductible, in order to start your family's benefit coverage.
For example, your family has a $2,500 deductible. This means you need to reach $2,500 as a family to start your benefit coverage. The $2,500 can be met by one or more family members, it doesn't matter.
Embedded deductible and out-of-pocket maximums:
1. One for the family as a whole
2. One for each individual member of the family
If a member of the family reaches his or her individual deductible, benefit coverage starts for that person. In order for other family members to get benefit coverage, they'll need to either:
Reach their own individual deductible;
The family reaches the family deductible by any combination of family members
This is the same for reaching the out-of-pocket maximums. Once an individual family member reaches his or her out-of-pocket maximum, she or he doesn't pay any more toward covered expenses. Once the family has reached the family out-of-pocket maximum, then the family, as a whole, pays no more toward covered expenses for the remainder of the plan year.
Embedded deductible example: You have a $2,000 family deductible with a $1,000 member deductible. Once you reach your $1,000 deductible you get coverage, even if other family members don't. Once the family deductible has been met, all family members get benefit coverage.
Embedded out-of-pocket example: You have a $4,000 family out-of-pocket with a $2,000 individual out-of-pocket maximum. Once you reach your $2,000 individual out-of-pocket maximum, you don't have to pay any more for your covered health care needs. Once the family out-of-pocket has been met, the family doesn't have to pay any more for covered health care needs.
High-deductible health plan
A plan in which you pay a high deductible before your coverage starts. With these plans, your monthly premiums are usually lower.
Health Reimbursement Account. This is a special spending account for medical costs. Your employer puts money into your HRA, which you can use to pay for eligible medical expenses determined by your employer.
Health Savings Account. This is a special savings account for medical costs. You and/or your employer put money into your HSA through payroll or direct deposits. You can save it or spend it on eligible medical expenses.
Three for Free
HealthPartners pays the doctor's fees for each of your family member's first three in-network doctor office, urgent care, or convenience care visits. After your first three visits, the amount you pay depends on your deductible and coinsurance.
The doctors, clinics and hospitals that are covered by your health plan.
Care from a doctor, clinic or hospital that is covered by your health plan. You'll usually pay less for in-network care.
Doctors, clinics and hospitals that are not part of your health insurance network. You'll usually pay more for out-of-network care.
The share of health care costs you're responsible for paying. It's usually listed as a percentage. If you have 80 percent coverage, that means you pay 20 percent of the total cost.
The amount you'll pay for medical services. It's usually a flat amount, such as $40, for each office visit. Copay is different from coinsurance, which is a percentage of the cost.
Amount you have to pay out-of-pocket before your coverage starts. It's usually listed as an "annual" amount.
The amount you pay for health care for expenses that aren't paid by your health plan. Out-of-pocket costs usually include your deductible, coinsurance and/or copays.
The annual amount you have to pay for your care before it's covered 100 percent by your plan (doesn't include premiums). This is the most you'll pay for your health care during the year.
What you (and your employer) pay for your insurance. Your share of premium is usually deducted from your paycheck by your employer.
A formulary is your health plan's covered list of medicines. You'll pay a lower copay or coinsurance for formulary medicines than non-formulary medicines.
A medicine sold under a trademark and patent protected name. While the medicine has a patent, it can't be made or sold by any other company. Brand name medicines are more expensive than generics and may not be covered by your health plan.
Medicines that are a copy of the brand name version.
Pharmacy deductible included in your medical plan
This is sometimes called an integrated plan. This means there's only one deductible and one maximum out-of-pocket you need to reach between your pharmacy and medical benefits.
Pharmacy deductible not included in your medical plan
This is sometimes called a non-integrated plan. This means you'll need to reach a deductible and out-of-pocket maximum for your pharmacy benefits and a deductible and out-of-pocket maximum for your medical benefits.
Pharmacy minimum copay benefits
This type of benefit has coinsurance and a minimum copay, which means you'll pay the minimum amount that's required for your medicine.
Pharmacy maximum copay benefits
This type of benefit has coinsurance and a max copay, meaning you'll pay for some of the medicine cost up to the max required.
Pharmacy minimum and maximum copay benefits
This type of benefit has a coinsurance with a minimum and max copay. With this benefit, you'll pay the minimum, but your cost will be capped at the max copay price.
Pharmacies are put into multiple benefit levels based on cost and quality. The amount you pay depends on the benefit level of your pharmacy. To save the most, use tier 1 pharmacies.
In network pharmacy tier 1
This pharmacy is in the network and can fill your prescription. You'll get the best benefit when you use a tier 1 pharmacy. They'll bill your claim so all you pay is your copay.
In network pharmacy tier 2
This pharmacy is in the network and can fill your prescription. As a tier 2 pharmacy, you won't get the highest benefit. They'll bill your claim so all you pay is your tier 2 copay. If you want the highest benefit, use a tier 1 pharmacy.
Out of network pharmacy
This pharmacy isn't in the network. Out-of-network pharmacies cost more, but they can fill your prescription in an emergency. You'll pay the full cost of the prescription to the pharmacy and submit a reimbursement form to the plan. Your cost may be higher than if you used an in-network pharmacy.