Glosario
Health insurance comes with its own vocabulary — here is what the terms on this site actually mean.
Questions about a bill, an Explanation of Benefits or an insurance term? Call a Quantum Health Care Coordinator at 844-460-2840, Monday–Friday, 8:30 a.m. to 10 p.m. ET.
A
AD&D insurance
Pays a benefit to you if an accident causes you to lose a limb, your speech, sight or hearing — or to your beneficiary if the accident is fatal. Dexter provides basic AD&D at no cost to you.
Allowed amount
The most your plan will pay for a covered service.
Ambulatory surgery center (ASC)
A facility for same-day surgery, such as cataract surgery, colonoscopies and some orthopedic procedures.
Ancillary
Services that support primary care — lab tests, X-rays, MRIs, physical therapy and home health care. They assist in diagnosing, treating or managing health conditions.
B
Balance billing
When a provider bills you for the difference between their fee and what the plan paid. If you get a bill like this and are not sure about it, call Quantum Health — they work to make sure you do not pay more than you should.
Beneficiary
The person or people you name to receive a benefit if you die. You name beneficiaries for life insurance, AD&D and your 401(k). Your primary beneficiary receives the benefit first; a secondary (contingent) beneficiary receives it if the primary beneficiary dies before or at the same time as you.
Brand-name drug
A drug sold under its trademarked name. For example, Lipitor is the brand name of a common cholesterol medicine.
C
CDHP (consumer directed health plan)
A medical plan with a higher deductible and a lower paycheck premium. Dexter offers two: the CDHP $3,500 and the CDHP $2,000. Enrolling in either makes you eligible for a Health Savings Account. Also called a high-deductible health plan (HDHP).
Claim
A request for payment that you or your provider sends to your plan after you receive care.
COBRA
A federal law that may let you and your dependents keep your health coverage for a limited time after it would otherwise end, such as when you leave Dexter. You pay the full premium plus a small administrative fee.
Coinsurance
A percentage of the cost you split with insurance. For example, you pay 20% and insurance pays 80%.
Copay
A flat fee you pay for a particular type of service, such as $25 for a doctor visit, on a PPO plan.
Cost at time of service
The amount you pay when you get care, like visiting the doctor or picking up a prescription.
Cost for coverage
The amount you pay biweekly or weekly for health insurance, often called a paycheck premium.
D
Deductible
What you pay before insurance starts sharing the cost. Copays do not count toward it.
Dental basic services
Fillings and simple extractions.
Dental major services
Root canals, oral surgery, crowns, bridges and dentures.
Dental preventive services
Exams, cleanings, fluoride, X-rays and sealants. Both Dexter dental plans cover preventive services at 100%.
Cuenta de gastos flexibles (FSA) para el cuidado de personas a cargo
Lets you pay for eligible care for your children under age 13 — day care, before- and after-school programs, preschool and summer day camp — with tax-free dollars. It also covers care for a spouse or other dependent who lives with you and cannot care for themselves.
E
Eligible expense
A service or product your plan or account covers. Your plan pays nothing toward an expense that is not eligible.
Embedded and aggregate deductible
Two ways a family deductible works. With an embedded deductible, the plan starts paying for a family member once that person meets the individual deductible — this is how the CDHP $3,500 and PPO $850 work. With an aggregate deductible, the whole family deductible must be met before the plan pays for anyone — this is how the CDHP $2,000 works.
Excluded service
A service your plan does not cover.
Explanation of Benefits (EOB)
A statement showing how your benefits were applied to a provider’s claim, what the plan paid and what you owe. An EOB is not a bill.
F
Facility
Physical locations where medical services are delivered — hospitals, clinics and surgery centers.
Formulary
The list of prescription drugs your plan covers. Also called a drug list or preferred drug list.
G
Generic drug
A drug with the same active ingredients as a brand-name drug, sold under a different name for less. For example, atorvastatin is the generic version of Lipitor.
H
Cuenta de gastos flexibles para atención médica (FSA)
Lets you pay for out-of-pocket medical, prescription, dental and vision expenses with tax-free dollars. You can roll over a limited amount into the next year; anything above that is forfeited.
Cuenta de Ahorros para la Salud (HSA)
A tax-free account you can open when you enroll in a CDHP. You use it for qualified medical, prescription, dental and vision expenses. The money is yours to keep — it rolls over every year and goes with you if you leave Dexter.
I
In-network
Providers that contract with a plan’s network and agree to set prices.
L
Life insurance
Pays your beneficiary a lump sum if you die.
Cuenta de gastos flexibles (FSA) de propósito limitado
An FSA for dental and vision expenses only. It is the FSA you can use if you or your spouse are enrolled in a CDHP with an HSA.
Long-term disability (LTD)
Replaces part of your income if you cannot work for an extended period because of a serious illness or injury.
M
Mail order
Having medicines you take regularly delivered to your home, usually in a 90-day supply for less. Rightway offers mail order through Walgreens Mail Service and Mark Cuban Cost Plus Drugs.
O
Open enrollment
The once-a-year period when you can change your benefit plans and the dependents you cover. Outside open enrollment, you can make changes only within 30 days of a qualifying life event, such as marriage or a new child.
Open network
You can see almost any doctor or hospital you choose. If a provider does not agree with the plan’s payment, your Quantum Health team works on your behalf to resolve it.
Out-of-pocket cost
Any health care expense you pay yourself — from your bank account, a credit card or an HSA or FSA.
Out-of-pocket maximum
Once you reach this amount, insurance covers 100% of eligible costs for the rest of the year.
Outpatient care
Care at a hospital or facility that does not require an overnight stay.
P
Plan year
The 12-month period your benefit elections cover.
Preferred brand drug
A brand-name drug on your plan’s preferred list. You pay less for preferred brands than for non-preferred brands.
Atención preventiva
Routine care that helps keep you healthy — screenings, check-ups, immunizations and counseling. Preventive care is covered at no cost on all Dexter medical plans.
Price protection
Built-in safeguards so you do not overpay for care. Every claim is reviewed to catch errors or overcharges, and payments are based on the fair price of the service.
Primary care provider (PCP)
The main doctor you see for routine care and health concerns. If you do not have one, Quantum Health can help you find one, and TextCare offers virtual primary care at no cost.
Professional
Medical professionals such as doctors, nurses and specialists who provide direct care to patients.
S
Short-term disability (STD)
Replaces part of your income when you cannot work for a limited time — for example, after surgery, during a prolonged illness or injury, or to recover from childbirth.
Specialty drug
A high-cost medicine used to treat complex conditions. Rightway can coordinate specialty prescriptions for you.
T
Telehealth
A visit with a provider by text, video or phone. Dexter’s TextCare telehealth visits cost you nothing.
U
Atención de urgencia
Care for an illness or injury that needs attention right away but is not severe enough for the emergency room. Urgent care usually costs much less than an ER visit.
V
Voluntary benefit
An optional benefit you pay for yourself, usually through payroll deduction — such as accident, critical illness and hospital indemnity insurance, voluntary life, legal, identity theft and pet insurance.
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