Need a reminder of what some of the terms mean? This list should help.
Coinsurance
Coinsurance is what you—the patient—pay as your share toward a claim. Coinsurance is a form of cost-sharing or splitting the cost of service between insurance company and employee. You typically pay coinsurance after meeting your annual deductible.
Deductible
The annual deductible is the amount you pay out-of-pocket each year before the medical plan starts to pay benefits for most services.
Flexible Spending Accounts – Healthcare and Dependent Care
A flexible spending account is an account that you put money into that you can use to pay for certain out-of-pocket health or dependent care costs. Money is set aside from your paycheck before taxes are taken out. You can use your pre-tax FSA dollars to pay for eligible health and dependent care expenses throughout the plan year.
High Deductible Health Plan (HDHP)
The HDHP has lower premiums in exchange for a higher deductible. The plan comes with a Health Savings Account (HSA) that you can use to pay for eligible health care expenses for yourself and your dependents. Carnegie contributes to the HSA on your behalf and you can make pre-tax contributions from your paycheck.
HSA: Health Savings Account
A health savings account (HSA) is a tax-advantaged medical savings account available to employees who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), HSA funds roll over and accumulate year to year if they are not spent. HSAs are owned by the individual.
HSA funds may be used to pay for qualified medical expenses at any time without federal tax liability or penalty.
Limited Purpose Health Care Flexible Spending Account (FSA)
A limited-purpose FSA is much like a typical, general-purpose health FSA. However, under a limited-purpose FSA, eligible expenses are limited to qualifying dental and vision expenses for you, your spouse, and your eligible dependents.
Out-of-Pocket Maximum
The out-of-pocket maximum is the amount you pay for most covered services during the year, including your deductible and coinsurance costs for medical care, prescription drugs, and services for mental health or substance use disorders. Once you reach an annual out-of-pocket maximum, the medical plan pays 100% of most covered expenses for the rest of the plan year. A separate out-of-pocket maximum may apply for out-of-network care.