BENEFIT GUIDE
JANUARY 1–DECEMBER 31 | 2025
WELCOME TO YOUR BENEFITS
WE’RE HERE BECAUSE OF YOU
MSD Washington Township Schools would not be the success it is today without the dedication of our hard-working employees. We are proud to offer a comprehensive benefits package to support your physical, mental, and financial wellness.
FIND EVEN MORE
This guide is a summary of the options available to you. Please refer to the detailed summary of benefits and coverage (SBC) for more information on each benefit.
Visit | MSDWT.K12.IN.US/hr/benefits ↖
COVERING YOU AND YOUR FAMILY
EMPLOYEES
MSD Washington Township Schools is proud to offer a comprehensive benefits package to all eligible administrators.
WHEN CAN YOU ENROLL?
SALARY POSITIONS
All elected benefits are effective on the first of the month following the first day of employment.
CLASSIFIED HOURLY POSITIONS
All elected benefits are effective on the first of the month following 30 days of employment.
ENROLLMENT DEADLINES
You must enroll within 31 days of the date your benefits would be effective, if elected.
Even if you are waiving all coverage, you must complete the enrollment process to indicate your decision.
IF YOU WAIVE A BENEFIT OR FAIL TO ENROLL:
Medical/Prescription Coverage | Unavailable to you until the next open enrollment period or within 31 days of a qualifying life event.
Dental and Vision Coverage | Unavailable to you enroll within 31 days of a qualifying life event.
Life and Short-Term Disability Insurance | Will be subject to approval by Sun Life and requires evidence of insurability. You could be denied coverage.
More on Qualifying Life Events ↖
LONG-TERM DISABILITY
The Collective Bargaining Agreement between MSDWT and the Washington Township Education Association (WTEA) requires all certified employees to enroll in long-term disability as a condition of employment and to pay 100% of the premium.
DEPENDENTS
Many of the plans allow you to cover your eligible dependents, which include:
• Legally married spouse
• Your eligible children, including biological, adopted, or foster children, as well as a stepchildren
Medical: until the end of the month in which the child turns 26
Dental: until the end of the year in which the child turns 25
Vision: until the end of the year in which the child turns 25
Life insurance: until the date the child turns 26
SPOUSAL RULE FOR MEDICAL COVERAGE
Spouses who have medical coverage through their employer’s health plan are not eligible to be covered on the MSD Washington Township Schools medical plan. Audits are conducted to ensure that all covered employees and spouses comply with this policy. Your spouse may be covered on the MSD Washington Township Schools plan if they are:
• unemployed
• retired
• self-employed
• employed, but their employer does not offer health insurance benefits to its employees
QUALIFYING LIFE EVENTS
ABOUT QUALIFYING LIFE EVENTS
“Qualifying life events” (QLEs) allow you to make a mid-year benefit change. Examples include:
• Marriage or divorce
• Birth or adoption of child
• Spouse’s open enrollment
• Change in work status (part-time to full-time)
• You and/or your dependents become eligible or lose coverage with another group health plan
ENROLLMENT DEADLINE
If you experience a QLE, you must request enrollment within 31 days of the date of the QLE. Coverage would be effective on the date of the event.
If you miss the 31-day window, you may be able to enroll during a open enrollment period, which typically happens in the fall each year.
STATE ASSISTANCE PLANS
There are two special enrollment opportunities with state assistance plans:
1. Coverage under Medicaid or CHIP (Children’s Health Insurance Program) is terminated as a result of loss of eligibility
2. Premium assistance for coverage under Medicaid or CHIP is approved by the state
NOTIFY HR
It is your responsibility to notify Human Resources:
• Within 60 days of losing Medicaid or CHIP coverage
• Or the date when eligibility for premium assistance under Medicaid or CHIP is determined
MEDICAL BENEFITS
REMEMBER THE HEALTH AND WELLNESS CENTER
You have the on-site health and wellness center, Marathon Health @ Northview. Many of the services at the clinic are FREE Learn more on the next page!
ON-SITE HEALTH AND WELLNESS CENTER
MARATHON HEALTH SERVICES
Marathon Health is MSD Washington Township Schools’ on-site health and wellness provider.
The center is available to employees and their family members who are enrolled in one of our medical plans.
MARATHON HEALTH @ NORTHVIEW
The Health and Wellness Center is conveniently located at Northview Middle School.
8401 Westfield Blvd Door 19A South Indianapolis, IN 46240
Call | 317-253-4987
Visit | MSDWT.K12.IN.US/hr/health-wellness-center
SEVEN CENTRAL INDIANA LOCATIONS
In addition to our on-site center at Northview, you can use any of the seven Marathon Health locations in the Indianapolis area.
SERVICE AT NO COST
Services and prescriptions provided at the health and wellness center are free!
SERVICES INCLUDE:
• Personal primary care
• On-site lab
• Preventive screening (physicals, Pap, etc.)
• On-site Rx (over 80 generic prescriptions available)
• Personal health coaching
• Chronic condition management
• Value-based referrals
VIRTUAL CARE NETWORK
Marathon Health CareAnywhere™ is a virtual care network with a dedicated care team that’s completely focused on you!
VISIT WHEN YOU NEED IT
To schedule a virtual visit, log in to the portal. For sick care after hours, the on-call team is available.
CAREANYWHERE™ SERVICES
MEDICATION AND LAB SERVICES
Prescriptions are available for conditions treated by our providers with home delivery.
BEHAVIORAL HEALTH SERVICES
Trained counselors can help you manage depression, addiction and substance abuse, anxiety and stress.
CONDITION MANAGEMENT
Coaching and education by Care Coaches for conditions such as diabetes, hypertension and high cholesterol. Digital tools are available, including Bluetooth/WiFienabled blood pressure cuffs and glucometers, for athome monitoring.
WELLNESS SERVICES AND HEALTH COACHING
Marathon can help with weight management, stress management, sleep improvement, and overall qualityof-life. Complete your annual physical and receive a home biometric lab kit to know your numbers.
PRESCRIPTION SAVINGS
TrueScripts provides you with personalized support to help manage and reduce your prescription drug costs.
You can contact TrueScripts whenever you have questions or need help navigating your pharmacy benefits. If you find that you’re paying a lot for your medications, they can often find ways for you to save!
PRICEPROTECTOR+
POWERED BY GOODRX
TrueScripts ensures you get the greatest savings possible while getting credit toward your deductible and out-of-pocket maximum.
With PriceProtector+, TrueScripts will automatically apply GoodRx discount card pricing if it is lower than the cost through your medical plan. No shopping around, no forms to send in, no headaches!
Learn more about PriceProtector+
MEMBER PORTAL
Register online with TrueScripts to manage your pharmacy benefits. Visit | MemberPortal.TrueScripts.com
FEATURES
• Recent claim history
• Network pharmacy locator
• Drug price lookup—check real-time pricing on medication!
• Live chat available
• Monday–Friday, 8 a.m. to 6 p.m. ET
QUESTIONS?
Call | 844-257-1955
SURGICAL SERVICES
INDIANA HAS THE FOURTH-HIGHEST SURGICAL COSTS IN THE COUNTRY
WellBridge Surgical wants to change that by providing quality surgical services at transparent, up-front prices. When you use WellBridge, you can pay less for your surgery without sacrificing quality.
WELLBRIDGE SURGEONS
WellBridge hand-picks its surgical team from some of the most prominent surgeons in their fields. They are the same top-tier surgeons, performing the same procedures at other Indiana hospital networks.
THE ONLY DIFFERENCE?
You get the benefits of their surgical talents at dramatically reduced prices.
SURGICAL SERVICES AVAILABLE:
• General orthopedic surgery
• Orthopedic upper extremity surgery
• Urology
• Gynecology
• General surgery
• Gastrointestinal (colonoscopy/endoscopy)
• Otolaryngology (Ear Nose Throat)
• Plastic surgery
• Podiatry
A FINANCIALLY SAVVY DECISION
WELLBRIDGE REWARD BENEFIT
If you or your family member enrolled on our medical plan has a covered procedure performed at Wellbridge Surgical Center, you will share in the savings.
You can receive $1,500 as a reward for helping MSD Washington Township Schools control costs.
CHOICE 2 HDHP PARTICIPANTS
When you use WellBridge Surgical for your outpatient procedures, you will pay a lower deductible on your medical plan.
YOUR WELLBRIDGE DEDUCTIBLE
$1,650 per individual and $3,300 per family
LEARN MORE
Call | 317-480-4200
Email | Info@WellBridgeSurgical.com
Visit | WellBridgeSurgical.com
ORTHOPEDIC SURGERY ALTERNATIVE
HOW DOES REGENEXX WORK?
Regenexx uses your body’s natural healing agents to replace the need for up to 70% of elective orthopedic surgeries by using your stem cells and blood platelets to repair and regrow damaged bone, cartilage, muscle, tendon, and ligament tissues.
Regenexx procedures treat a broad range of chronic and acute orthopedic injuries. Whether you suffer from the lingering aches and pains often associated with aging or a tear or sprain due to activity, Regenexx may be able to help return you to full function without invasive surgery.
WHAT DOES IT COST?
Regenexx is covered as an in-network benefit with the MSD Washington Township Schools medical plans. You’ll receive in-network rates for your deductible, coinsurance, and copays for any Regenexx services.
NATIONAL NETWORK
Regenexx has a national network of interventional orthopedics clinics.
Each Regenexx physician receives hundreds of hours of hands-on training in our proprietary procedures to make sure that every patient receives the highest quality of care.
WHERE CAN I FIND A PHYSICIAN?
Regenexx has physicians at 99 locations nationwide, including Carmel, Indiana.
WHAT DOES REGENEXX TREAT?
Spine | Ruptured or torn disc, disc extrusion, back or neck nerve pain, bulging disc and more
Hand/Wrist/Elbow | Arthritis, carpal tunnel, tennis elbow
Knee | Arthritis, meniscus tear, tendinopathy
Shoulder | Rotator cuff tears, labral tear, arthritis
Hip | Osteonecrosis, bursitis, tendinopathy and more
Ankle/Foot | Instability, bunions, plantar fascitiis
LEARN MORE
Visit | RegenexxBenefits.com/msdwt
Call | 866-257-5523
PREVENTIVE CARE
Your medical plan covers in-network preventive care services at no cost to you! Preventive care can help keep you healthy and identify minor issues early, when they’re easier—and less costly—to treat.
☐ WHAT’S PREVENTIVE CARE?
Preventive care includes a range of services to help keep you healthy.
While regular, diagnostic medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place.
☐ WHAT’S NOT PREVENTIVE CARE?
If you see a doctor because you have symptoms or have been diagnosed with an illness, the services are not preventive. Your medical plan still provides coverage, but they are not covered at 100%.
Your plan may charge a fee if you visit an out-of-network provider or if preventive service is not the primary purpose of your visit.
Visit | Anthem.com/preventive-care
Call Anthem to confirm which preventive services are covered under your medical plan.
HEALTHCARE ON THE GO
YOUR SYDNEY HEALTHCARE APP
With Sydney, you can find everything you need to know about your Anthem benefits—personalized and all in one place. Sydney makes it easier to get things done, so you can spend more time focused on your health.
• Access your digital ID card
• Find care and check costs
• View your benefits coverage
• Check claims and deductible expenses
• Get answers even faster with the chatbot
DOWNLOAD THE APP
Visit | SydneyHealth.com for a link to download the app.
TIPS TO SAVE MONEY
☐ SAVE THE EMERGENCY ROOM FOR TRUE EMERGENCIES
Only visit the emergency room if you have a lifeor limb-threatening emergency. If you need care when your doctor’s office is closed, check your area for an urgent care location or use virtual care.
☐ USE IN-NETWORK PROVIDERS
Your medical, dental and vision costs increase greatly when you visit a provider who is not in your plan’s network. Always confirm your provider is in your network, especially when being referred to another provider or facility for services.
You can even use the Sydney app!
☐ GET YOUR ANNUAL CHECKUP
You and your dependents should visit the doctor annually for health screenings and tests. Your plan covers preventive services at 100%.
☐ CHOOSE GENERIC PRESCRIPTIONS
Ask your doctor or pharmacist to give you generic prescriptions instead of brand name. Generic drugs are cheaper and are just as effective.
☐ SHOP AROUND TO FIND THE BEST PRESCRIPTION PRICES
It can pay to shop around. Drug comparison tools like GoodRx.com and SingleCare.com can help you find the lowest cost for medication near you.
Note: GoodRx and SingleCare also offer discount cards and coupons, which can provide additional savings. However, you will not receive credit toward your plan deductible or out-of-pocket maximum if you use them. Talk with your doctor and pharmacist to determine the best option for you.
☐ USE THE MAIL-ORDER PHARMACY
Save time and money by using the mail-order prescription drug program for your maintenance prescriptions. Check with your insurance company for more details.
HEALTH SAVINGS ACCOUNT
By enrolling in the Choice 2 HDHP medical plan, you can establish a Health Savings Account (HSA) with Everwise Credit Union, which can be used to pay for qualified healthcare expenses.
ELIGIBILITY
Anyone who fits all of these conditions may contribute to an HSA:
✓ IS enrolled in an HSA-eligible HDHP medical plan.
x IS NOT enrolled in Medicare, Tri-Care, Medicaid, or a medical plan with copays.1
x IS NOT eligible to be claimed as a dependent on someone else’s tax return.
1Medicare & your HSA: Because enrollment in Part A is backdated by six months, you should stop your HSA contributions six months prior to enrollment to avoid penalties. Consult your tax advisor for guidance.
HSA CONTRIBUTION LIMITS
You can contribute up to the IRS annual maximum, which is based on your age and enrollment in the HDHP medical plan.
SET UP YOUR HSA
Open your HSA with Everwise Credit Union. Contact the Shadeland branch with any questions.
Visit | EverwiseCU.com/HSA
Use promo code WASHINGTONHSA
Email | Shadeland@EverwiseCU.com
Call | 317-577-1313 ext. 5736
AFTER YOU OPEN YOUR HSA
Complete the HSA Payroll Authorization Form and provide a hard copy to the payroll department (CEC).
• You must complete a new form to make changes or cancel an existing HSA.
CHANGE YOUR HSA CONTRIBUTION
To change your existing HSA contribution, complete a new HSA Payroll Authorization Form and provide a hard copy to the payroll department (CEC).
LEARN MORE ABOUT YOUR HSA
Explore the HSA Store for all things HSA! Start with the learning center and shop specific categories online.
The IRS defines family as having at least one dependent.
Visit | HSAStore.com/learning-center.html
EMPLOYEE ASSISTANCE PROGRAM
HERE TO HELP YOU
MENTAL HEALTH COUNSELING, SUPPORT AND REFERRALS
You, your spouse and dependent children have access to Employee Assistance Programs (EAP) to help with everyday life challenges that may affect your health, family life and desire to excel at work.
FREE AND CONFIDENTIAL
There is no cost to you to use the EAPs. It’s completely confidential when you use an EAP—the district will not be notified if you use it.
AN EAP CAN ADDRESS:
WORK & CAREER
DENTAL BENEFITS
WHAT YOU PAY FOR SERVICES
*Be aware of balance billing if you use an out-of-network dentist.
If your dentist is out-of-network and they charge more than what the plan allows, you are responsible for the extra charges. Save money by staying in-network! See Benefit Glossary on page 26 for more details.
Please refer to the summary of benefits and coverage (SBC) for more information. Visit | MSDWT.K12.IN.US/hr/benefits ↖
YOUR DENTAL NETWORKS
Your dental plan offers three levels of dental providers: Delta Dental PPO, Delta Dental Premier and Out-of-Network. For the greatest benefits and discounts, choose a dentist in the PPO network.
Save the most with a PPO dentist.
The PPO network is Delta Dental’s lowest-cost network.
If you can’t find a PPO dentist, a Premier dentist is next best.
The Premier network is Delta Dental’s largest network.
You’ll pay the most if you visit an out of network dentist.
Out-of-network dentists have not contracted with Delta Dental for lower rates, so you pay more. Plus, you're subject to “balance billing.”
VISION BENEFITS
Our vision coverage is through VSP. There’s no ID card necessary–just tell your provider you have VSP.
PLAN BASICS
VSP VISION PLAN IN-NETWORK*
NETWORK Signature
Eye Exam once every 12 months $15 copay
Eyeglass Lenses Single | Bifocal | Trifocal once every 12 months $15 copay
Contact Lenses—instead of glasses once every 12 months $150 allowance
FRAME BENEFITS
Frames once every 24 months
$170 allowance + 20% discount on remainder
If you buy a featured frame brand extra $20 allowance + 20% discount on remainder
If you buy your frames from Costco $95 allowance
*Out-of-network coverage is available on this plan. Please refer to the summary of benefits and coverage (SBC) for more information. Visit | MSDWT.K12.IN.US/hr/benefits ↖
DISCOUNTS & SAVINGS
Just for being a VSP member, you are eligible for extra discounts and savings when you visit in-network providers!
LEARN MORE Visit | VSP.com
FLEXIBLE SPENDING ACCOUNTS
Flexible Spending Accounts (FSAs) allow you to set aside money from your paycheck to pay for eligible healthcare and dependent care expenses with tax-free dollars. By participating in an FSA, you can reduce your taxable income and enjoy 20–30% savings on expenses you are already paying! Learn more and find resources for managing your account You are not required to enroll in MSD Washington Township Schools insurance to contribute to a FSA. Visit | My.HealthEquity.com
HOW IT WORKS
1. ESTIMATE
Estimate your expenses and decide how much you want to contribute. Estimate carefully!
2. CONTRIBUTE EACH PAY
Your contributions are deducted each paycheck before taxes are applied and set aside in your FSA.
3. SPEND YOUR FUNDS!
During the year, use your FSA debit card to pay for eligible expenses or reimburse yourself from your account.
HEALTHCARE FSA
not available for HSA participants
DEPENDENT CARE FSA
Medical, dental and vision expenses for yourself, your spouse and your dependent children
See what’s eligible! FSAStore.com/fsa-eligibility-list
Dependent care expenses for a dependent parent or a child under age 13 that allow you to go to work Examples: Daycare, day camp, after-school programs
ESTIMATE CAREFULLY!
$3,300
All funds available to you at the beginning of the plan year
Allows a 2½-month grace period following plan year end to allow you to incur expenses
$5,000
$2,500 if married and filing separate tax returns
Funds available as you contribute through payroll deductions
Allows a 2½-month grace period following plan year end to allow you to incur expenses
FSAs are “use it or lose it” accounts. That means any unused money at the end of the year is forfeited, so only contribute what you know you will spend in the year. The one exception to the “use it or lose it” rule is the grace period, which allows you an extra 2½-months after the plan year ends to incur expenses.
LIFE INSURANCE
BASIC LIFE AND AD&D ONLY $1 PER YEAR
To help provide financial security for your family in the event of death or dismemberment, we provide basic term life and accidental death & dismemberment (AD&D)* coverage for only $1 per year. Find your coverage details online.
| MSDWT.K12.IN.US/hr/benefits ↖
*The AD&D benefit is paid in addition to the life benefit if your death is due to an accident. A partial AD&D benefit may be paid in some instances such as loss of sight or paralysis. See plan summary for details.
SUPPLEMENTAL LIFE AND AD&D
Supplemental life and AD&D insurance provides a layer of financial security for your family. You can give your loved ones greater peace of mind by purchasing voluntary coverage at competitive group rates.
COVERAGE DETAILS
Employee Benefit
Spouse Benefit
Child Benefit
$5,000 increments up to $500,000 or 10× your annual salary
Guarantee Issue: $200,000
$1,000 increments up to $50,000
Guarantee Issue: $50,000
$5,000 increments up to $10,000
Note: Your cost for voluntary life and AD&D varies by age and coverage amount and will be provided to you when you enroll.
GUARANTEE ISSUE
A “guarantee issue” amount is the dollar amount of coverage you can be approved for without completing a health questionnaire—also commonly referred to as Evidence of Insurability (EOI).
Guarantee issue amounts only apply during your initial enrollment period when hired.
If you want to enroll in Supplemental Life and AD&D or increase your coverage after your initial eligibility period, you will be required to complete the EOI.
NEW EMPLOYEES
Don’t miss your guaranteed issue opportunity!
DISABILITY INSURANCE
Disability benefits replace part of your income if you’re unable to work due to a non-work-related injury or sickness.
MSD Washington Township Schools provides long-term disability coverage at no cost to you. You may also choose to purchase short-term disability coverage, so you don’t have a gap in coverage before your long-term benefits kick in.
SHORT-TERM DISABILITY
Benefit
When are
Benefit amount 60% of your salary up to $2,500 per week
When are benefits payable? 16th day of disability due to an accident, illness or pregnancy
Maximum benefit duration 50 weeks
Pre-existing condition exclusion (3/12): If you have been diagnosed or treated for a condition 3 months prior to your benefit effective date, that condition will not be covered until you have been enrolled on the plan for 12 months.
LONG-TERM DISABILITY NO COST TO YOU!
Benefit amount
When are benefits payable?
662/3% of your salary up to $7,778 per month
After 90 consecutive days of disability due to an accident or illness
Maximum benefit duration Up to age 70
Pre-existing condition exclusion (3/12): If you have been diagnosed or treated for a condition 3 months prior to your benefit effective date, that condition will not be covered until you have been enrolled on the plan for 12 months.
THE IMPORTANCE OF DISABILITY INSURANCE
Most people don’t realize how likely it is to miss work due to an accident, illness, injury, or pregnancy.
If you couldn’t work, how would you pay your bills?
1 in 4 people will experience a disabling condition in working years.*
*Council for Disability Awareness. Working years defined as age 20 through retirement age.
RETIREMENT BENEFITS
Achieving financial well-being takes retirement planning. The district provides several retirement options.
403(B) SAVINGS PLAN
A 403(b) plan—also called a Tax-Sheltered Annuity plan (TSA)—is a retirement savings plan offered by public schools and certain 501(c)(3) tax-exempt organizations. MSD Washington Township Schools offers a 403(b) plan through Corebridge Financial. Employees contribute to individual accounts which include a variety of investment options.
DISTRICT CONTRIBUTIONS
Visit the MSD Washington Benefit Group Listing ↖ Vesting requirements apply.
NEXT STEPS
1. Meet with an AIG representative to review investment options and make your elections.
2. Complete an enrollment form to open your account and authorize payroll deductions for your contributions.
3. You must enroll so your account can be created. Otherwise, your contributions can’t be deposited via payroll deduction.
401(A) SAVINGS PLAN
A 401(a) plan provides you with an additional way to save toward retirement. The name simply refers to the section of the tax code which governs such plans. The district offers a 401(a) savings plan through MetLife and employees contribute to individual accounts which include a variety of investment options
DISTRICT CONTRIBUTIONS
Visit the MSD Washington Benefit Group Listing ↖ Vesting requirements apply.
NEXT STEPS
1. Meet with a MetLife representative to review investment options and make your elections.
2. Complete an enrollment form to open your account and authorize payroll deductions for your contributions.
3. You must enroll so your account can be created. Otherwise, your contributions can’t be deposited via payroll deduction.
RETIREMENT BENEFITS CONTINUED
VEBA RETIREE HEALTHCARE SAVINGS ACCOUNT
The VEBA Plan is a 501(c)(9) Trust that is funded with a Health Reimbursement Account (HRA). The District offers a VEBA plan, with a variety of investment options, through Indiana HRA.
While a VEBA plan is designed to provide funds to cover healthcare expenses during retirement, once you separate employment from MSD Washington Township Schools, you may access the funds if you have met vesting requirements.
DISTRICT CONTRIBUTIONS
Visit the MSD Washington Google Drive to learn more ↖ Vesting requirements apply.
NEXT STEPS
You will be automatically enrolled—no form required.
INDIANA PUBLIC RETIREMENT SYSTEM
Indiana Public Retirement System (INPRS) oversees the administration of the various state retirement funds for public employees, including the Teachers Retirement Fund (TRF) and Public Employees Retirement Fund (PERF). The fund is a retirement account designed to help you achieve financial well-being.
Eligible public school employees are automatically members of INPRS and will have an individual Annuity Savings Account funded by a 3% mandatory contribution.
DISTRICT CONTRIBUTIONS
Per state law, contributions are paid either by the INPRS member via payroll deductions or by the employer on the member’s behalf.
The district will contribute the entire 3% on your behalf, submitted on a bi-weekly basis. You will not be responsible for any of the 3% contribution. Vesting requirements apply.
NEXT STEPS
Visit | IN.gov/inprs
1. Visit the INPRS website to log into your account and review your personal information.
2. Keep your INPRS account updated—beneficiary changes, name change, address changes.
3. Only you can make changes to your INPRS account.
BENEFIT CONTACTS
SEARCH FOR AN IN-NETWORK PROVIDER
SAVE MONEY BY STAYING IN NETWORK
BENEFIT GLOSSARY
BALANCE BILLING
When you are billed for the difference between the provider’s actual charge and the amount reimbursed under the medical, dental or vision plan. This occurs when you go outside of the preferred provider network. Balance billing does not apply toward your out-ofpocket maximum.
COINSURANCE
The percentage of the cost you pay for covered services after you meet your deductible.
COPAYMENTS (ALSO CALLED COPAYS)
A flat fee you pay for a covered healthcare service. You will typically pay your copay at the time of service, and then the plan will pay any remaining amount.
DEDUCTIBLE
The amount you are required to pay each year before certain benefits are paid for by the plan. Once you meet the deductible amount, expenses are covered by the plan based on the coinsurance percentage. The deductible resets on Jan. 1 each year.
EXPLANATION OF BENEFITS (EOB)
A packet, usually mailed to you, that explains how your claim was processed by the insurance company. The EOB details what portion of the claim was paid by the insurance company and what portion is your responsibility.
HEALTH SAVINGS ACCOUNT (HSA)
An HSA is a special, tax-advantaged, interest-bearing savings account you can use for qualified healthcare expenses such as your deductible, copayments, and other out-of-pocket expenses.
HIGH-DEDUCTIBLE HEALTH PLAN (HDHP)
A plan with a higher deductible than a traditional insurance plan. You pay more healthcare costs yourself before the insurance company starts to pay its share. An HDHP can be combined with a HSA, allowing you to pay for certain medical expenses with money free from federal taxes.
NETWORK
The doctors, hospitals, and other healthcare providers your insurance company has contracted with to provide services at discounted rates. You will pay less when you use in-network providers. Some plans will not cover the care you get outside of the network.
OUT-OF-POCKET MAXIMUM (OOPM)
The most you pay in a year for covered services. If you reach the OOPM, the plan pays 100% of covered expenses for the rest of the calendar year.
PLAN YEAR
The plan year refers to Jan. 1 through Dec. 31.
USUAL, CUSTOMARY, AND REASONABLE (UCR) CHARGES
Healthcare charges determined by your health insurance provider and based on the range of fees charged by doctors with comparable training and experience for the same or similar service in your area. When you receive in-network care, UCR charges do not apply. You are responsible for amounts over UCR for out-of-network care.
The information in this enrollment guide is based on information provided by the employer and various benefit documents. While every effort was taken to accurately report your benefits, discrepancies or errors are always possible. In case of discrepancy between this guide and the actual plan documents, the plan documents will prevail. All information is confidential pursuant to the Health Insurance Portability and Accountability Act of 1996.
Guide prepared by The MJ Companies.