Deductible: A specific dollar amount that your health insurance company may require that you pay out-of-pocket each year before your health insurance plan begins to make payments for claims. Not all health insurance plans require a deductible. As a general rule (though there are many exceptions), HMO plans typically do not require a deductible, while most Indemnity and PPO plans do.
PC/Specialist: Primary Care Provider / Specialist.
Co-Insurance: The amount that you are obliged to pay for covered medical services after you've satisfied any co-payment or deductible required by your health insurance plan. Coinsurance is typically expressed as a percentage of the charge or allowable charge for a service rendered by a healthcare provider. For example, if your insurance company covers 80% of the allowable charge for a specific service, you may be required to cover the remaining 20% as coinsurance.
OOP Limit (Out Of Pocket Limit or Maximum): An annual limitation on all cost-sharing for which patients are responsible under a health insurance plan. This limit does not apply to premiums, balance-billed charges from out of network health care providers or services that are not covered by the plan.
Inpatient Hospital Care: The amount you are obligated to pay for hospitalization services after your deductible has been met.
In Net / Out Net: In Network Costs (lower) vs. Out of Network Costs (higher)
Rx Generic: Generic prescription medication costs for a 30-day supply.
Rx Preferred: Brand name prescription medication costs for a 30-day supply.
Rx Non-Preferred: Specialized prescription medication costs for a 30-day supply.
EE (Eligible Employee): An employee who is eligible for insurance coverage based upon the stipulations of the group health insurance plan.
EE Cost: Full premium cost for an Eligible Employee.
DEP (Eligible Dependent): A dependent (usually spouse or child) of an insured person who is eligible for insurance coverage.
DEP Cost: Full premium cost for an Eligible Employee’s dependents.
Total Premium Cost: EE Cost plus DEP Cost
ER Total: The portion of an employee's health insurance premium paid for by the employer. This amount may be as low as 50% of the cost of the lowest sponsored plan made available to employees.