Your 2024 Benefits Resource

Benefit Terms and Definitions

To better understand your coverage, it’s helpful to be familiar with benefits vocabulary. Take a moment to review these terms, which may be referenced throughout this website.

Benefit Acronyms

AD&D: Accidental Death & Dismemberment
EAP: Employee Assistance Program
FSA: Flexible Spending Account
HDHP: High Deductible Health Plan
HMO: Health Maintenance Organization
HSA: Health Savings Account
LTD: Long-Term Disability
OOPM: Out-of-Pocket Maximum
PPO: Preferred Provider Organization
STD: Short-Term Disability

Terms and Definitions

When a health care provider bills a patient for the difference between what the patient’s health insurance chooses to reimburse and what the provider chooses to charge.

A fixed dollar amount you pay the provider at the time of service.

The percentage paid for a covered service, shared by you and the plan. You are responsible for coinsurance until you reach your plan’s out-of-pocket maximum.

The amount you pay each plan year before the plan begins paying benefits. Not all covered services are subject to the deductible.

Care received at a hospital emergency room for life-threatening conditions.

A list of preferred drugs chosen by a panel of doctors and pharmacists. Both brand and generic medications are included on the formulary.

Care provided by contracted doctors within the plan’s network of providers. This enables participants to receive care at a reduced rate compared to care received by out-of-network providers.

Care provided by a doctor or at a facility outside of the plan’s network. Your out-of-pocket costs may increase, and services may be subject to balance billing.

The maximum amount you pay per year before the plan begins paying for covered expenses at 100%. This limit helps protect you from unexpected catastrophic expenses.

What you pay from your paycheck to participate in each plan. You may share this cost with your employer or be responsible for the full amount.

Routine health care including annual physicals and screenings to prevent disease, illness, and other health complications. In-network preventive care is covered at 100%.

Urgent care centers are helpful when care is needed quickly to avoid developing more serious pain or problems. Visit urgent care for sudden illnesses or injuries that are not life threatening.

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Understanding Your Medical Plans

What is an HDHP?
Two of your medical plan options are High Deductible Health Plans, or HDHPs. An HDHP provides you with more control over how you spend your health care dollars, as well as the flexibility to see any provider that you’d like. Please note that you should check to ensure your provider is considered in-network for savings (as compared to out-of-network providers). You also may be eligible to establish and contribute to a Health Savings Account (HSA), which allows you to spend pre-tax dollars on qualified health care expenses. Note: if you are enrolled in any other non-HDHP health plan, including Medicare, you are not eligible to contribute pre-tax dollars to an HSA.

What is an HSA?
A Health Savings Account, or HSA, is a tax-free savings account available to employees enrolled in an HDHP. Genesys contributes to your HSA, and you can also elect to contribute additional money up to IRS limits. Your HSA funds can be used to pay for current or future eligible health care expenses with tax-free dollars. Additionally, your HSA balance is portable if you leave Genesys — it’s a great way to save for health care, dental and vision expenses now and into retirement. Think of it as your health care 401(k).

What is a PPO?
One of your medical plan options is a traditional Preferred Provider Organization, or PPO. A PPO grants employees access to the same network as the HDHP plans; however, you’ll pay a copay for many services, and for this benefit, you’ll pay more out of your paycheck for the PPO plan. The Genesys PPO plan does not have a deductible.

What is an HMO?
If you currently work in California, you’re eligible to enroll in the Kaiser Health Maintenance Organization, or HMO plan. Just like with a PPO, you’ll also be asked to pay a copay at the time of service for both doctor visits and prescriptions.

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Aggregate vs Embedded Deductible

What’s the difference?
If you’re considering enrolling yourself and your covered dependents in one of the HDHP medical plans, it’s important that you understand how the family deductible works under each of the options. HDHP Plan 1 has an “aggregate” family deductible, while HDHP Plan 2 has an “embedded” plan deductible. Here’s what those terms mean:

Aggregate Family Deductible:
The full family deductible must be met before the plan begins to pay a portion of expenses for any covered family members.

Embedded Plan Deductible:
If one covered family member has enough expenses in a calendar year to meet the individual deductible, the plan will begin paying a portion of that family member’s expenses for the remainder of the year. You do not have to meet the full family deductible before the plan begins to pay.

What is a Deductible?
The amount you need to pay each year before the plan starts paying benefits. For example, if your deductible is $2,000, your plan won’t pay anything until you’ve paid $2,000 for covered healthcare services, unless copays apply.

Click here to see an example scenario of how each plan’s deductible works.

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