Terms to Know
Out-of-pocket expenses are healthcare expenses that you pay for with your own money. These could be things like coinsurance before you meet your DuPont Medical Plan deductible or copays for medical services, like going for a doctor’s office visit.
Depending on the type of expense, and whether you’re eligible for a Health Savings Account or Flexible Spending Account, you may be eligible to submit these expenses for reimbursement.
High-Deductible Health Plan
A high-deductible health plan, which is commonly referred to as an “HDHP,” is a plan with a higher deductible than a traditional medical plan. This means you’ll pay out of pocket for your healthcare expenses until you meet the deductible. The HDHP comes with lower monthly premiums and a Health Savings Account (HSA). The HSA can be used to pay for eligible out-of-pocket expenses.
A deductible is a fixed dollar amount you pay each plan year before your DuPont Medical Plan begins paying benefits.
Your paycheck premiums are the monthly amounts you pay to be enrolled in your DuPont benefits.
Preferred Provider Organization Plan
A Preferred Provider Organization Plan — better known as a “PPO” — is a medical plan that requires you to use healthcare providers in the PPO provider network. If you use a healthcare provider outside of the PPO provider network, you’ll pay more for services.
A formulary is a list of drugs that are determined and maintained by CVS Caremark and Archimedes and are covered under their prescription drug programs. The formulary is designed to help healthcare providers prescribe drugs that are medically necessary for your treatment and are cost-effective.
A copayment — better known as a copay — is a fixed amount you pay before you receive a covered healthcare service. Copay amounts will vary, depending on the type of provider you use and the service you receive.
In-network providers are healthcare providers that are contracted with your DuPont Medical Plan provider and have agreed to certain healthcare rates. Because of this, you’ll pay less for services when you use an in-network provider rather than an out-of-network provider.
It’s important to contact your Accolade Health Assistant before receiving medical care to ensure that the services you’re receiving are in-network.
Out-of-network providers are healthcare providers that are not contracted with your DuPont Medical Plan provider and have not agreed to certain healthcare rates. Because of this, you’ll likely pay more for services if you use an out-of-network provider instead of an in-network provider.
Maximum Annual Benefit
Your maximum annual benefit is the most your plan will pay (in terms of dollar amounts) in a plan year.
Your lifetime benefit is the cumulative dollar amount that your plan will pay for the life of the enrollee or the existence of the plan.
Preventive care is healthcare measures taken to prevent diseases.
For example, your annual physical is considered preventive care. During your annual physical, your healthcare provider will conduct a biometric screening, such as a blood pressure exam and laboratory tests, to give you a clearer picture of your overall health. These tests can detect and alert you of potential health conditions, such as diabetes, high blood pressure, and heart disease.
Through preventive care, you can identify any health risks early and get ahead of them before they turn more serious.
Coinsurance is a percentage of costs of a covered healthcare service that you pay. For example, your DuPont Medical Plan may pay 90% of the cost of a healthcare service. This means you’re responsible for paying the remaining 10%. Your coinsurance does not include deductibles or copays.
Qualifying Life Event
Qualifying life events are occasions — like a birth, an adoption, or a marriage — that change your or your dependent’s eligibility for benefits. You have the opportunity to make changes to your DuPont benefits within 30 days of the qualifying life event.