Benefits FAQ

Benefits

 

The amount of money payable to a claimant under an insurance policy or plan.

Brand Name Drugs

Prescription drugs sold by a drug company under a specific name or trademark and protected by a patent. Brand name drugs may be available by prescription or over the counter.

Exclusions and Limitations

Exclusions are general disclaimers to protect the plan against certain types of losses. Even though documentation is received that states services are medically necessary, there may be a specific exclusion for the service. Medical policies include an exclusions and limitations section specifying what is not covered under the plan.

Flexible Spending Account (FSA)

An individual arrangement set up through employers to pay for many out of pocket medical expenses with tax-free dollars. The FSA account holder sets aside a pre-tax dollar amount for the year which they can use to pay for medical expenses. Unused FSA funds can expire, depending on the policy of the account holder's employer.

Summary of Benefits and Coverage (SBC)

SBCs provide standard information about health plan options to allow individuals to make informed decisions about which plan to choose.

Telemedicine

The remote diagnosis and treatment of patients by means of telecommunications technology. This is commonly done by phone and is a convenient option for those who would rather not leave home, or who are unable to leave home.