Terms You Should Know Limited Spousal Eligibility. If your spouse is employed and Embedded deductible plans. Under family coverage, an your spouse’s employer provides a medical plan for which embedded deductible plan means that each family member the employer pays at least 50% of “Employee Only” has an individual deductible in addition to the total family coverage, your spouse must enroll in that plan in order to deductible. Each individual's deductible is much lower than be eligible to enroll in any of the DePauw University Medical the total family deductible. When an individual meets their plans. respective out-of-pocket total, the insurer begins to pay for Deductible. The amount you pay for covered health care that person's covered medical services, regardless of expenses before your insurance starts to pay. For example, whether the family deductible has been fulfilled. with a $2,000 plan year deductible, you pay the first $2,000 • The benefit of embedded deductibles: in some cases, covered services. this double-layered deductible can actually enhance individuals' coverage, according to the Center for Health Coinsurance. The percentage of costs of a covered health Insurance Reform at Georgetown University. If an care service you pay (for example 20%), after you have paid individual family member incurs a significant amount of your plan year deductible. medical expenses, the individual will fulfill their deductible sooner because it is lower than the family Out-of-Pocket Maximum. The most you have to pay for deductible. This can save families thousands of dollars covered services in a plan year. After you spend this amount because the individual's insurance policy will begin to on deductibles, copayments, and coinsurance, your health cover benefits even if the family deductible isn't met. plan pays 100% of the costs of covered benefits. Non-embedded deductibles. Under a non-embedded Network Benefits (In-Network). In network providers deductible plan, also known as an aggregate deductible agree to accept the UMR’s approved amount for their plan, the total family deductible must be paid out-of-pocket services. You will see these savings listed as the “discounted before the insurer starts paying for healthcare services for amount” on your Explanation of Benefits statements. any individual member. • Non-embedded deductibles are not economical for Non-Network Benefits (Out-of-Network). Doctors or some families. For some families, such as married hospitals who are not in the network do not accept the couples without children, non-embedded deductible UMR’s approved amount. You will be responsible for paying plans can cause families to spend thousands of dollars the difference between the provider’s full charge and your in extra out-of-pocket expenses that otherwise would plan’s approved amount. This is called balance billing. have been covered had they purchased individual plans Preventive Care. Preventive care is the care you receive to with lower deductibles or embedded family plans. prevent illnesses or diseases. Providing these services at no Plan Compliance Notifications. Federal required Notices cost is based on the idea that getting preventive care, such including but not limited to the HIPAA Privacy and Security, as screenings and immunizations, can help you and your Certificate of Creditable Coverage for Medicare and Market family stay healthy. Services will be paid at 100% when you “Exchange” Notices. Health Care Reform Notices are use a participating provider. available online on the human resources internet site or via Consumer Driven Health Plan (CDHP). Refers to a type of paper, free of charge, upon request. Please contact human health insurance plan that allows employers and/or resources with questions. employees to utilize pretax money to help pay for medical expenses not covered by their health plan. These plans are often linked to health savings accounts (HSAs). This benefit guide only highlights the benefits available. For a more complete description, see the Plan Certificate. 4 If any conflict should arise between this summary and the Plan, the Plan's Certificate will govern in all cases.