Issue link: http://townofcary.uberflip.com/i/1164390
TOWN OF CARY Benefits Handbook Page 6 UPDATING YOUR CONTACT INFORMATION Use the Employee Demographic/Emergency Contact Form to notify Cary of changes to your address, contact information or emergency contact. WHAT IS A DEDUCTIBLE? A deductible is the dollar amount you must pay before benefits are paid under the Plan. Costs for a copayment are not included and not counted toward the deductible. If one or more dependents are covered, you each have an individual deductible and your family has a combined family deductible. WHAT IS A COPAYMENT? When you are on the Medical – Traditional Plan (PPO), a copayment is a fixed dollar amount you must pay for some covered services at the time you receive them. A copayment covers most services at a provider's office. Copayments also apply to urgent care and emergency room services. Copayments are not credited to the deductible but do count toward the out-of-pocket maximum. The Medical – High Deductible Health Plan (HDHP) does not have copayments. WHAT IS COINSURANCE? Coinsurance is the amount Cary pays, and you pay after you have satisfied your benefit period deductible. So, if a service is covered at 80%, Cary pays 80% for the service and you as the member are responsible for 20% of the service. WHAT IS THE OUT-OF-POCKET MAXIMUM? The out-of-pocket maximum is the most you will pay for healthcare services during the plan year. All copays, deductibles and coinsurance payments go towards the out-of-pocket maximum. Once you have reached your out-of-pocket maximum, any additional services are covered at 100% for the rest of the year. WHO PAYS WHAT THE EMPLOYEE DOESN'T PAY? Cary pays for any cost that you are not responsible for paying. For example, if a procedure costs $40,000, and you as the employee is responsible for paying $2,000, then Cary is responsible for the $38,000 remaining balance. WHAT IS AN IN-NETWORK PROVIDER? A healthcare provider that participates within a plan that has contracted with Cary to provide medical, dental, and/or vision care to its employees and members. Overview of Benefits Eligibility and Process TERMS TO KNOW Here are key terms to help you understand how your benefits work OOP stands for out-of-pocket.