Glossary
Connecting to your benefits starts with knowing these common benefits terms.
Allowable charge – This applies to out-of-network care; it’s the most an insurance
plan will pay for care you get outside the network. You’re responsible for paying any
amount above the allowable charge, even if you’ve already reached the out-of-pocket
maximum for out-of-network care.
Annual deductible – This is the amount you must pay out of pocket each calendar year
before the plan pays benefits. The amount depends on the plan, the number of people
you cover and whether you use in-network or out-of-network providers.
The money you pay to meet the deductible counts toward the out-of-pocket
maximum.
Out-of-pocket maximum – This is the most you’ll pay in a calendar year for covered
medical care. Once you reach it, your plan will pay 100% of covered expenses for the
rest of the calendar year. The maximum is based on the plan you choose, the number
of people you cover, and whether you use in-network or out-of-network providers.
Copays, coinsurance and the deductible count toward the out-of-pocket maximum.
Coinsurance – Once you meet the annual deductible, the plan will share costs
with you until you meet the out-of-pocket maximum. This cost sharing is called
coinsurance. If your plan pays 80%, your coinsurance is 20%. Coinsurance varies by
plan and may be different for in-network and out-of-network care.
The money you pay in coinsurance counts toward the out-of-pocket maximum.
Copay – This is a fixed amount you pay for care, like an office visit or a prescription.
For example, if you pay a $25 copay for an office visit, the plan pays the rest of the cost
for that visit; the annual deductible doesn’t apply. Copays vary by plan and may be
different for in-network and out-of-network care.
Your copays count toward the out-of-pocket maximum.
Imputed income – The IRS considers the value of certain company-paid benefits — for
example, long-term disability, life insurance that’s more than $50,000 and dependent
life insurance — as taxable income.
If you enroll your domestic partner and their children in your health insurance, the
value of that benefit is considered imputed income so will be taxed. Imputed income
appears on your paychecks and W-2 Wage and Tax Statement.
Preventive care – This is routine health care, like screenings and checkups, that helps
prevent illnesses and disease. Preventive care includes but isn’t limited to:
• Annual physicals
• Blood pressure, diabetes and cholesterol screenings
• Age-appropriate immunizations
• Routine cancer screenings
• Certain preventive medications
All Samsung medical plans cover 100% of in-network preventive care.