Glossary

Coinsurance

The percentage of your health care cost that you must pay after meeting the deductible or copayment. For example, a plan may cover 80 percent of the cost of a service and leave you responsible for 20 percent of the cost. That 20 percent is coinsurance.

Copayment

The flat dollar amount that you pay at the time you receive health care services. For example, you may pay a $25 copayment for a physician’s visit. Copayments do not count toward your annual deductible or out-of-pocket maximum.

Coverage Tier

How the University categorizes whom you wish to cover (example: You + Spouse).

Deductible

The deductible is the dollar amount that you need to pay out-of-pocket before your health care plan begins to pay benefits. (Generally, the larger your deductible, the smaller your premium contribution.)

Flexible Spending Account (FSA)

A taxadvantaged account into which you make contributions to pay for eligible health or dependent care expenses, such as deductibles, copayments, over-the-counter items, and some health care services not covered by the health care plan. Northwestern offers three FSAs types: a health care FSA; a dependent care FSA; and for participants in the Value PPO, a limited-use FSA.

Health Savings Account (HSA)

A special investment account established by people who are enrolledin a high-deductible health care plan such as the Value PPO plan; it is used to pay for current and future medical expenses. Contributions to an HSA may be made by an employer, an individual, or both.

Network

A group of doctors, hospitals, and pharmacies organized by a health care plan to provide

health care services to the members. To get the maximum coverage for the lowest cost, you generally must use the plan’s network. (In a PPO, you have the option to use out-of-network providers, but it will cost you more.) Generally, you visit your plan’s web site to locate participating doctors and facilities.

Out-of-Pocket Maximum

The maximum amount that you pay out-of-pocket each year for health care services. This includes deductibles and coinsurance but not office copayments. Most health care plans have a yearly maximum for out-of-pocket expenses. Once you reach the maximum for the period, the plan pays 100 percent for any remaining covered health care expenses.

Premium Contribution

The dollar amount deducted from your paycheck to pay for your coverage.

Preventive Care

The term used for regularly scheduled checkups with your doctor to identify health risks and prevent, diagnose, and treat illnesses so they can be found in early, more treatable stages.

Primary Care Physician (PCP)

A primary care physician is doctor who is intended to be your primary doctor and helps to determine when you need to see a specialist. If you enroll in an HMO, you usually must select a PCP.

Wellness Benefits

At Northwestern University, we encourage faculty and staff to practice healthy lifestyles, and we offer employee programs throughout the year to teach and support healthier behaviors.