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
CHANGE
OF
ADDRESS?
Updating your
address, emergency
contact, or other
demographic
information is easy!
Complete the
Employee
Demographic/
Emergency Contact
Form and submit to
Human Resources.
