Acute medications
Prescribed to treat short-term symptoms for a specified period of time.

Aggregate deductible
The full family deductible must be met before the plan covers expenses for any one covered member. Therefore, a family member with high medical expenses could contribute the entire family deductible amount before any coinsurance kicks in. This applies to the HSA Advantage Plan.

Allowed amount
When you visit providers who are out-of-network, these providers may charge you for the amount your medical plan does not cover – the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, you may be responsible for the $30 difference (after you meet your deductible and pay your coinsurance or copay).

Balance Billing
When you visit providers who are out-of-network, these providers may charge you for the amount your medical plan does not cover – the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, you may be responsible for the $30 difference (after you meet your deductible and pay your coinsurance or copay).

Beneficiary
A person (or entity) who is designated to receive the benefit or funds upon the death of the insured.

Brand-name medications
A medication that is considered a preferred brand-name by your Pharmacy Benefit Manager (PBM), is determined to be effective at a medium cost to you.

CHIP
CHIP stands for Children’s Health Insurance Program and provides affordable coverage for kids in low-income families. Children might be eligible for CHIP even if their parents don’t qualify for Medicaid. Routine doctor and dental checkups are free under CHIP. Like Medicaid, you can apply for coverage any time, all year round. 

Coinsurance
The portion (percentage) of an eligible expense you pay once the deductible has been met.

Copay/Copayment
The fixed dollar amount you’ll pay at the time of service.

Deductible/Annual Deductible
What you pay out of your own pocket (by individual or for the family, depending on the plan) before the plan begins to pay a share of your costs. For example, with a $1,500 deductible you pay the first $1,500 of covered services yourself (out-of-pocket). At the beginning of every year, your deductible resets to zero.


Dependent care flexible savings account (FSA)

A tax-advantaged bank account that allows you to pay for qualified expenses like preschool, summer day camp and day care for a child or dependent adult. The amount you decide to contribute to the account for the year is deducted from your salary before income taxes. Unused funds do not roll over from year to year.

Embedded deductible
Once a covered member meets the individual deductible, the plan covers his/her expenses, even if the full family deductible amount has not been met. This applies to the Signature Plan.


Evidence of insurability (EOI)
An online medical history questionnaire completed by the employee and/or spouse sometimes needed for insurance coverage.

Formulary
A list of medications that are approved by the Food and Drug Administration (FDA) and are covered under your prescription drug plan. You should make sure your medications are on the formulary of the medical insurance plan you choose.

Generic medication
Medications that have been approved by the FDA as safe and effective. Generic medications are required by the FDA to have the same active ingredients in the same amounts as their brand-name version. Generics may be different in color, shape or size from their brand-name counterparts. Your physician may substitute a generic for a brand-name drug to save you money.

Healthcare flexible savings account (FSA)
A tax-advantaged bank account that allows you to pay for eligible medical expenses. The amount you decide to contribute to the account for the year is deducted from your salary before income taxes. Unused funds do not roll over from year to year.

Health savings account (HSA)
A special bank account that allows you to set aside tax-free money to pay for qualified healthcare expenses. These include your medical, dental and vision copays, deductibles and coinsurance. Funds roll over from year-to-year.
It can also be an effective long-term savings vehicle to help cover health care expenses in retirement.

Health system network
Always your lowest-cost option, this includes facilities and providers for covered services within The University of Kansas Health System in the Kansas City, Great Bend and Topeka areas.

In-network
A group of healthcare providers and facilities that offer services to participants in the health plan at a negotiated, discounted cost. You’ll save money if you use doctors inside the network.


Independent deductible

The deductible for out-of-network providers is separate from, and in addition to, the deductible for health system and in-network providers.

Independent out-of-pocket maximum
The out-of-pocket maximum for out-of-network providers is separate from, and in addition to, the out-of-pocket maximum for health system and in-network providers.

Maintenance medications
These require long-term, regular use to treat a chronic condition.

Out-of-network
Providers and facilities not included in the network of your plan, resulting in higher cost to you.


Out-of-pocket maximum

The most you’ll ever have to pay for covered services in the calendar year. After you hit this, you’ll have no copays or coinsurance – the plan will pay 100% of the cost of all covered services for the rest of the calendar year.


Pharmacy benefit manager (PBM)

The company that manages your prescription drug benefit. The health system has selected Navitus Health Solutions for this role beginning in 2023.

Plan maximum
The maximum amount the carrier will pay per member.

Premium
The amount deducted from your paycheck to cover your share of benefit costs.

Pretax dollars
Money deducted from your paycheck before taxes are withheld.

Preventive care/services
Annual physicals, wellness screenings, immunizations, well-woman exams, well-baby exams and more. In-network preventive care is 100% covered without having to pay your deductible.

Primary care physician/provider
A physician who provides a broad range of healthcare services.


Specialist physician/provider
Focuses on a specific area of medicine or group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.

Specialty medications
High-cost medications used to treat a chronic or complex health condition.

Vest/vested
This is another word for “own.” It’s the amount that belongs to you in your retirement plan.

Voluntary benefits
Services and/or goods offered by the health system at a discounted group rate and paid for by employees who choose it through payroll deduction.

Whole life insurance
This type of insurance policy pays a benefit to your beneficiary. This coverage accumulates a cash value and can be used while you are living.