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Contact Us:
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Office Hours: Monday -Friday
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Health Glossary of Terms
Deductible health maintenance organization (DHMO) plan
With a DHMO plan, you simply pay the charges for services up to a certain amount in a contract or calendar year, which is called your deductible. Once you meet your deductible, you just pay a copayment or coinsurance for covered services in that contract or calendar year. After you meet your out-of-pocket maximum, the health plan pays for any covered services (not including applicable copayments or coinsurance).
Not all services you pay for apply toward your deductible. Some services, such as certain preventive care visits and prescriptions, are available to you right away for just a copayment—you don't need to satisfy your deductible first. Copayments for these services don't apply toward your deductible, but in most cases, they will count toward your annual out-of-pocket maximum.
Health maintenance organization (HMO) plan
An HMO plan ordinarily has a closed network of physicians and other health care providers, and sometimes its own hospitals. With a traditional HMO plan, you receive services from the HMO's providers for a fixed, predetermined copayment. You pay only copayments for services, and you don't have to worry about submitting claim forms unless you receive medical services outside the network.
Health reimbursement arrangement (HRA)
HRAs are individual accounts that your employer can establish to help pay for covered medical expenses. Your employer decides how much money to put in the HRA and whether unused HRA funds can roll over from year to year. You can withdraw HRA funds for medical expenses allowed under your employer's HRA plan. HRA funds belong to the employer and are not portable, which means they do not go with you if you change jobs. Your HRA fund is not treated as taxable income.
Deductible/coinsurance plan with health reimbursement arrangement (HRA)
The Custom Care HealthBuilder (HRA) pairs a deductible health plan with a CarePaySM HRA account that lets you use funds contributed by your employer to pay for covered medical expenses, including deductibles, coinsurance, and copayments. Your HRA funds are easily accessible through the CarePay HRA Visa® debit card issued upon enrollment and can be used any locations where Visa® cards are accepted, including physicians' offices, hospitals, pharmacies, and other health care-related businesses.
Deductible/coinsurance plans offer comprehensive coverage with lower premiums than traditional HMO plans. These plans typically have copayments for the things you routinely need, like preventive services and prescriptions. However, you must meet a specified deductible for other services. Once you meet your deductible, you just pay a copayment or coinsurance. After you meet your out-of-pocket maximum, we pay for most covered services. When paired with a CarePay HRA, you will have access to a special account that your employer funds for you. You can use the money to pay for your deductible, coinsurance and copyaments.
Health savings account (HSA)
An HSA is a tax-exempt savings account that you open, which can be used to pay for qualified medical expenses. Contributions to an HSA can be made by both you and your employer, but the money belongs to you. The money you invest in the HSA is tax-deductible, and earnings are tax-deferred. You can withdraw funds tax-free and without penalty if you use them to pay for qualified medical expenses. The HSA is portable and goes with you if you change jobs.
Deductible health plan with health savings account (HSA)
A deductible health plan combined with a health savings account provides health care coverage and a way to help you save for future medical expenses while receiving tax benefits. It also gives you greater flexibility and control over how you use your health care dollars.
A plan with a health savings account is a deductible health plan. This means you simply pay the charges for services up to a certain amount, which is called your deductible. Once you meet your deductible, you just pay a copayment or coinsurance for covered services. After you meet your out-of-pocket maximum, your health plan pays for any covered services. (Note: There are no copayments or coinsurance under a deductible plan with health savings account once the out-of-pocket maximum is reached.) Deductible plans with health savings accounts usually have higher annual deductibles and annual out-of-pocket limits than other deductible plans and, unlike some other deductible HMO plans, copayments always apply towards fulfillment of your annual out-of-pocket maximum.
Not all services you pay for apply toward your deductible. Some services, such as certain preventive care services, are available to you right away for just a copayment—you don't need to satisfy your deductible first. For non-preventive medical care, you must first meet the plan deductible before the health plan pays for covered services. You can choose to pay your deductible with funds from your HSA, or you can choose to pay for your deductible directly out-of-pocket, allowing your HSA account to continue to grow.
In-area services
Services provided within a designated geographic area covered by the health plan.
Network
A group of doctors, hospitals, pharmacies, and other providers that have contracted with a health plan to provide services to its members at negotiated rates.
Out-of-area plan
If you live outside your health plan's service area, you may still obtain a wide range of health benefits by purchasing an out-of-area plan. You may receive care for covered services from any licensed provider who is not part of the health plan's network. You must meet an annual deductible, pay coinsurance, and submit claims for reimbursement.
Point-of-service (POS) plan
In a point-of-service plan, you can choose from three coverage options each time you need medical care to get the health care that best meets your needs.
In Tier 1 (in-network), you receive services from a health plan provider that is part of the health plan's limited provider network, and you generally pay a copayment for services.
In Tier 2 (contracted network), you may receive care from a provider network. (Networks vary by region.) You are also responsible for satisfying a deductible and paying coinsurance for services, and the coinsurance is generally higher than the copayments in Tier 1.
In Tier 3 (out-of-network), you may receive care from any licensed provider or hospital of your choice that is not part of your health plan's Tier 1 or Tier 2 networks of contracted providers. When you choose this option, you'll generally have higher out-of-pocket expenses than if you had used Tiers 1 or 2. You are also responsible for satisfying a deductible and/or paying coinsurance charges.
Preferred provider organization (PPO) plan
In a preferred provider organization (PPO) plan, you can choose from two coverage options each time you need medical care to get the health care that best meets your needs.
In Tier 1 (contracted network), you may receive care from a contracted provider network. (Networks vary by region.) You are responsible for satisfying a deductible and paying coinsurance for services.
In Tier 2 (out-of-network), you may receive care from any licensed provider or hospital of your choice that is not part of your health plan's network of contracted providers. When you choose this option, you'll generally have higher out-of-pocket expenses than if you had used Tier 1. You are also responsible for satisfying a deductible and/or paying coinsurance charges.
Not all terms and definitions are applicable in all regions; terms, definitions, and coverage levels may vary at the service area level.
 Or call Toll Free: 1-800-831-3270,
contact or email us!
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Contact Us:
Toll Free at
1-800-831-3270
Office Hours: Monday -Friday
7:45am - 9pm EST
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