Glossary of Benefits Terms
Coinsurance - the shared financial responsibility for services covered by the health plan.
Copayment - the set amount that you will pay when you access covered services.
Deductible - the amount that you must pay before your health plan begins to pay for covered services.
EPO (Exclusive Provider Organization) – a health plan that uses the same network as the PPO plan, however, there are no out-of-network benefits available. All services are covered with a copayment or percentage coinsurance.
FSA (Flexible Spending Account) - this account allows participants to use pre-tax dollars to pay for eligible expenses.
Generic drug - prescription medications that are produced by multiple manufacturers and not identified by a brand name.
HMO (Health Maintenance Organization) – a health plan that uses a network of participating providers. Participants must use these providers for all medical care in order for the services to be covered.
Indemnity Plan - a health plan that is not tied to any particular network. Participants may use any provider, however a deductible must be met before any services are covered, participants must file their own claims and may be responsible for paying the difference between the Usual, Customary and Reasonable charge and what the provider charges.
In-Network Providers - providers who have agreed to accept a negotiated rate from the health plan as payment in full for covered services.
Major Restorative - dental repair or replacement of teeth. Examples include root canals, bridges, crowns and dentures.
Minor restorative - common dental repairs including simple extractions, one to four surface fillings and periodontics such as root planing and one scaling.
Non-preferred brand drug (also known as a non-formulary brand drug) – prescription medication that may be produced by multiple manufacturers. Usually one or more medications within a therapeutic class are considered preferred, and the remaining medications within that class are considered non-preferred.
Out-of-Network Providers - providers who have not entered into an agreement with the health plan. They do not accept the UCR as payment in full and may bill participants for the difference between the UCR and their normal charge.
Participating pharmacy - a pharmacy that has entered into an agreement with Express Scripts to provide prescription medications to you and your covered dependents and accept the coinsurance and copayments for those medications.
Personal Care Account (PCA) - the amount provided to each participant on the UK Health First plan (a consumer driven health plan) to be used for first dollar coverage of covered services. For the 2003-2004 plan year, the amount provided is $500 per participant.
PPO (Preferred Provider Organization) – a health plan that uses a broader network than an HMO. Services obtained from participating providers are covered at a higher rate than services obtained from non-participating providers. A deductible applies to certain services.
Preferred brand drug (also known as a formulary brand drug) - brand name prescription medication that has been selected to be on the preferred list either because it is only produced by one manufacturer, or because it is preferred over other available medications within the same therapeutic class.
Preventive Care - services such as annual physical exams, mammograms, Pap smears and prostate antigen testing.
UCR (Usual, Customary and Reasonable) –this is the amount that has been established by the health plan as the acceptable charge for each service. Participating providers agree to accept this amount as payment in full for covered services. Non-participating providers may bill for the difference between the UCR and what they charge.
Vesting - Employees hired prior to January 1, 2010 are immediately 100% vested. This means the 10% employer match, as well as your 5% employee contribution, belongs to you from day one.
Employees with start dates on or after January 1, 2010 must work for the University for a period of 3 years to see the UK-contributed portion of their accounts become “vested.” In other words, employees (hired on or after January 1, 2010) who leave the University before completing 3 years of service will not keep any portion of those retirement account funds (10% match) contributed by the University over that time period. Employees hired on or after January 1 will have full access to the 5% employee-contributed portion of their retirement account(s).