This list of key terms includes many commonly used terms but is not a full list. These terms and definitions are intended to be educational.

A deductible is the dollar amount that you must pay towards covered services before the insurance plan will begin to pay their portion. The deductible amount may vary based on whether it is individual or family coverage.

The percentage or amount that you are required to pay in conjunction with your insurance plan after the deductible has been met.

A fixed payment that an insurer may require you to pay for certain covered expenses, such as office visits or prescription drugs. Copays go toward your out-of-pocket maximum.

The out-of-pocket maximum is the total amount of money you will be responsible for throughout the plan year. This amount includes deductibles, coinsurance, and copayments. Once the out-of-pocket maximum is met, the insurer will pay 100% of the allowed amount for covered services for the remainder of the benefit period.

Out-of-network means that a provider does not contract with the health insurance plan. In many cases, the insurance company will not pay or will pay substantially less for services you receive from an out-of-network provider. Out-of-network claims may be subject to balance billing. In these instances, the provider may bill the patient for the difference between what your insurance pays and what the provider bills.

Inserso currently offers two (2) QHDHPs, referenced as HSA and Low HSA.

An HSA is a tax-advantaged account that you can use to pay for qualified medical expenses that your QHDHP does not cover.

You can only contribute to an HSA if you are enrolled in a QHDHP.

A PPO is managed health care insurance that provides maximum benefits if you visit an in-network physician or provider but may provide some coverage for out-of-network physicians and providers. A PPO plan is not considered a QHDHP.

Inserso currently offers one (1) PPO plan, referenced as an OAP.

An in-network only plan only offers in-network coverage. Out-of-network benefits are not covered under this plan.

Inserso currently offers one (1) in-network only plan, referenced as an OAPIN.

A FSA is a type of savings account that provides the accountholder with specific tax advantages that allows you to set aside pretax dollars from your pay, which may be used to cover eligible out-of-pocket Health Care or Dependent Care expenses throughout the calendar year.

A Limited Purpose FSA is an FSA that is compatible with a Health Savings Account (HSA). If you are enrolled in a QHDHP and have an HSA, you can maximize your savings by pairing your HSA with a Limited Purpose FSA to pay for dental and vision expenses.

Medical / Pharmacy Plan Options

Also known as a Qualified High Deductible Health Plan, or QHDHP

Offers in- and out-of-network coverage

Eligible to contribute to an HSA

Also known as a Qualified High Deductible Health Plan, or QHDHP

Offers both in- and out-of-network coverage

Eligible to contribute to an HSA

There are no out-of-network benefits under this plan

Offers both in- and out-of-network coverage

Deductibles: Aggregate vs. Embedded Examples

Sample Plan

Individual Deductible: $1,500

Family Deductible: $3,000

Aggregate Family Deductible

With an aggregate family deductible, your family will be paying the deductible until the entire family deductible is collected. The HSA plan has an aggregate deductible.

Jack falls, sprains his wrist and needs to go to the emergency room. Will the coinsurance kick in immediately since he has already met the $1,500 individual deductible?

No, Jack (and all family member) will continue to pay the full cost of treatment until the $3,000 family deductible is met.

Embedded Family Deductible

With an embedded family deductible, the plan begins to make payments as soon as one member of the family reaches their individual deductible. The OAPIN, OAP, and Low HSA plans have embedded deductibles.

Jack falls, sprains his wrist and needs to go to the emergency room. Will the coinsurance kick in immediately since he has already met the $1,500 individual deductible?

Yes, however, other family members will continue to pay until each of their individual $1,500 deductible is met OR the family deductible of $3,000 is met.

Have a question?

Send your questions to HR@inserso.com and someone from our Human Resources team can help.
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