Key Terms to Know
Mystified by benefits jargon? Don’t worry—we’ve got you covered. This quick glossary breaks down the key terms so you can feel more confident when reviewing your options and making decisions.
Insurance Terms
Pharmacy Terms
Beneficiary
The person you choose to receive your benefits, such as Life Insurance money, if something happens to you.
Coinsurance
The portion of covered expenses you and the plan share after you meet the deductible (listed as a percentage).
Copay
A fixed dollar amount you pay the provider at the time you receive a service.
Deductible
The amount you pay for services before the plan begins paying some of the cost. The deductible may not apply to all services, including preventive care.
Generic
A medicine with the same active ingredients as a brand-name drug but usually costs much less.
In-Network
A group of doctors, hospitals, and clinics that have agreed to provide care at lower negotiated costs for your insurance plan.
Non-Preferred Brand
A brand-name drug not favored by the insurance plan and usually comes with a higher cost.
Out-of-Pocket Maximum
The maximum amount you pay out of your own pocket for covered expenses in a year. Once you reach the out-of-pocket maximum, the medical plan pays for all covered services for the rest of the year. The out-of-pocket maximum does not include premiums or services the plan does not cover.
Preferred Brand
A brand-name drug that’s favored by the insurance health plan and typically costs less than other brand-name options.
Preventive Care
Routine checkups, age-appropriate screenings, and vaccines that help you stay healthy and catch problems early—usually covered at no cost.
Primary Care Physician (PCP)
Your main doctor who handles general health needs and helps coordinate any other care you may need.
Prior Authorization
A requirement where your doctor must get approval from your insurance before it covers certain medications.
Specialist
A doctor who focuses on a specific area of medicine, like a dermatologist for skin or a cardiologist for the heart.
Specialty
High-cost or complex medications that are used to treat serious or chronic conditions, often requiring special handling or delivery.
