Glossary

Also known as a “living will,” this legal document notifies your doctor what kind of care you want/don’t want.

The limit to which your health plan will pay. This amount is in addition to your plan’s required copays and deductibles.

Care a person receives in a clinic, ER, hospital or surgery center without an overnight stay. Also known as “outpatient.”

This is the person you elect to receive your assets should you die.

A request to be paid by a health plan for health services provided.

This is the percentage of health care costs you pay after meeting your deductible—but before reaching your out-of-pocket maximum.

A copayment or copay is a fixed payment for a covered service—like doctor visits, prescription drugs and other health care services—that you pay when you receive the service.

You’re responsible for paying for 100 percent of your care until you reach this amount, called the deductible. After that, your plan will pay a percentage of the cost if you stay in network.

A person who is covered by another’s plan. It can include a spouse or child.

Term that is used to decide who can receive coverage. Requirements can include time of employment or job status.

A formulary is a list of generic, brand-name and specialty drugs identified as providing the greatest overall effectiveness and value.

A network is a group of health care providers. It includes doctors, dentists and hospitals. 

Cleveland Clinic EHP offers the Cleveland Clinic Quality Alliance network of providers and additional contracted providers in specialties where we have gaps.

Cleveland Clinic EHP Plus offers the Cleveland Clinic Quality Alliance in addition to the Aetna Select Open Access network.

Cleveland Clinic EHP for ONA, USW and Main Campus Residents and Fellows offers a two-tier network of providers. The Cleveland Clinic Quality Alliance network of providers comprise the Tier 1 Provider Network. Aetna Select Open Access network comprises the Tier 2 Provider Network.

Cleveland Clinic EHP for Florida Region members offers the Cleveland Clinic Quality Alliance network of providers as the Tier 1 Network. UMR Choice Plus comprises the Tier 2 Network.
 

The accrued value of copay and co-insurance payments that has to be satisfied in the plan year before the reimbursement for covered services will be paid in full.

This is the amount you pay for your coverage. In general, plans with lower premiums have higher deductibles and out-of-pocket expenses and vice versa.

This type of care is used to help you stay healthy, identify risks and stop illness. Preventive care includes child and adult screenings for a wide range of services, including immunizations and yearly exams.

This is a doctor responsible for your basic care. They may also provide referrals for specialized care.

You may be able to enroll or change your coverage outside annual enrollment if you have a qualifying life event—like marriage, divorce, spouse job loss, birth or adoption of a child, death of a dependent, loss of other benefits coverage, etc.