Glossary

Coinsurance

After you meet your deductible, the plan will begin paying coinsurance for medical expenses. Coinsurance is your share of the costs of a covered service, calculated as a percent of the medical expenses for the service.

Copay

A fixed amount you pay for a covered service under a plan, usually when you receive the service. The amount can vary by the type of service.

Covered Dependents

Your eligible dependents whom you have enrolled for coverage under one or more of Shelby County’s plan options.

Deductible

The amount you owe for covered health care services (other than preventive services) before the plan begins to pay.

Generic Drug

An alternative form of a brand-name drug that has been shown to be equally effective while also being less costly.

Health Reimbursement Account (HRA)

An HRA is an employer-funded account that you can use to pay for eligible healthcare expenses if you are enrolled in the HRA Choice Gold or HRA Standard Bronze plan.

In-Network

Providers or health care facilities that are part of the health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider.

Out-of-Network

Physicians, hospitals, or other health care providers who are considered non-participants in an insurance plan. Depending on the plan you choose, expenses incurred by services provided by out-of-network professionals may not be covered or may be covered only in part by your insurance.

Out-of-Pocket Maximum

This is the maximum amount you and your covered dependents need to pay each plan year toward your covered expenses before the plan pays covered expenses at 100%. The out-of-pocket maximum includes deductibles, copays, and/or coinsurance.

Preventive Care

Services designed to prevent or detect illness before the condition develops or becomes more severe (for example, annual physicals, screenings and immunizations). All of the Shelby County Government Medical plans cover in-network preventive care at 100%, according to age and frequency limits.

Qualified Life Events

A change in your life, like getting married or having a baby, that allows you to enroll in or change your benefits during the plan year. If you have a life event during the year, you must contact the Shelby County Benefits Center within 31 days of the event.