LM_SW_Benefits Guide 2024

Glossary of Terms • Balance Billing: The difference between an out-of-network provider’s charge and the amount allowed by the insurance plan. For example, if the provider’s charge is $200 and the allowed amount is $110, the provider can bill you for the remaining $90. • Coinsurance: Your portion of the costs after the plan’s deductible has been met. The coinsurance is typically expressed as a percentage (%) meant to illustrate the share you will pay of the allowed amount. EXAMPLE: 80% coinsurance means you will pay 20% of the allowed amount and the insurance carrier will pay 80%. • Copayment: a predetermined fixed cost you pay at the time of service, regardless of the actual cost of the service provided. • Deductible: The amount you must pay before the plan begins to cover health services. » Embedded (Individual) Deductible Accumulation for Family Coverage: OAP medical plan: After each family member meets their individual deductible, their benefits will be paid by coinsurance up to the individual out-of-pocket maximum. The same applies if all family members together meet the family deductible. » Aggregate Deductible Accumulation for Family Coverage: HSA medical plan: the family deductible must be met by all covered members before benefits will be paid by coinsurance up to the total family out-of-pocket maximum. • In-Network: A list of providers and facilities that have contracted with the carrier to provide services at a discounted rate. Your costs are significantly discounted when you see in-network providers and facilities because they agree to accept a discounted, or “allowed amount,” for the payment of services they provide. • Out-of-Network: A provider who doesn’t have a contract with the medical plan to provide services. You’ll usually pay more to see an out-of-network provider than an in-network provider for services rendered. » Be aware your in-network provider might use an out-of-network provider for some services (such as lab work). Check with your in-network provider before you get services. • Out-of-Pocket Maximum: A plan’s safety-net feature. Once you have spent money “out-of-pocket” through a combination of deductible, coinsurance, and/or copayments, the insurance carrier will then pay 100% of every service thereafter for the rest of the plan year. » Embedded (Individual) Out-of-Pocket Accumulation for Family Coverage: OAP medical plan: After each family member meets their individual out-of-pocket maximum, their benefits will be paid 100% for the remainder of the plan year. The same applies if all family members together meet the family out- of-pocket maximum. » Aggregate Out-of-Pocket Accumulation for Family Coverage: HSA medical plan: the family out-of-pocket maximum must be met by all covered members before benefits will be paid 100% for the remainder of the plan year. • Preventive Care: Healthcare Reform requires all plans to cover Preventive Care Services (annual exams, colonoscopies, mammograms, child immunization, etc.) at 100% in-network and do not apply toward the in- network deductible. Certain age and frequency limitations may apply.

Log into www.workforcenow.adp.com and click on Resources – Company Information – Tools/Resources – 2024 Benefit Documents for details. In the event of a discrepancy, the carrier Plan Document shall prevail.

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