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About Your Health Plan
Our goal is to administer world-class medical coverage that supports your health and overall well-
being. The first thing you should do as a member is to choose a personal care physician (PCP). This will
be your go-to doctor and first-line partner for better health. Your PCP will know your medical history
and refer you to the right specialists if ever a need arises. You have lots of doctors to choose from, too.
If you already have one, chances are your PCP is already part of your network. As far as emergency and
urgent care, you’re covered no matter where you go.
Important Health Plan Words to Know
The amount you owe for certain covered services before your health plan begins to pay for them. There
are per person (individual) deductible amounts and family deductible amounts.
A set amount you pay each time for a covered service, or the purchase of prescriptions or other
medical supplies. The copay amount can vary by the type of covered health care service.
The percentage of charges for certain covered services that you pay after your deductible has been
met. (Coinsurance can vary by plan, and some plans don’t have it at all.)
Out-of-Pocket Limit**
The most you will pay for the combined total of all copays, coinsurance and deductibles for covered
services in a benefit period (usually a calendar year). Once you meet your out-of-pocket limit, your
plan pays all of the allowed amount for covered services.
Personal Care Physician (PCP)
A PCP is a plan-affiliated doctor who is usually an internist, general or family practitioner, or pediatrician.
The relationship you have with your PCP is important because he/she is the person who knows your
complete medical history and will make sure you get the right care you need – including care from
a specialist.
* Copays do not count toward the deductible. You will continue to pay copays after you have met your deductible, until reaching your
out-of-pocket limit. This does not apply to grandfathered plans.
** The out-of-pocket limit never includes your monthly premium or non-covered services.