Medical Insurance - Definitions

PPO (Preferred Provider Organization)

• A flexible health plan that lets you see any doctor or specialist without a referral.

• Staying in-network saves you money.

• Out-of-network care is covered at a higher cost.

HDHP (High Deductible Health Plan)

• A health plan with higher deductibles but lower premiums.

• Often paired with a Health Savings Account (HSA).

HSA (Health Savings Account)

• A tax-advantaged account available to employees with an HDHP.

• Use it for qualified medical expenses.

• Funds roll over year to year and are employee-owned.

The amount you pay out-of-pocket for covered services before your insurance starts paying.

Example: A $2,000 deductible means you pay $2,000 in covered expenses before coinsurance applies.

A fixed amount you pay for specific services, such as doctor visits or prescriptions.

Example: $25 for a primary care visit, $10 for generic prescriptions.

• The most you pay in a plan year for covered in-network care.

• Includes deductibles, copays, and coinsurance.

• Once reached, the plan pays 100% of covered expenses.

Doctors, hospitals, and providers contracted with UHC to offer services at discounted rates. You pay less when using in-network providers.

Providers who are not contracted with UHC. You may pay more or the full cost of services.

Services like annual checkups, immunizations, and screenings. Covered 100% in-network, even if you haven’t met your deductible.