Glossary

How much you'll pay each year before your insurance starts helping. For example, if your deductible is $1,000, you'll pay that out of pocket first before your plan kicks in.

A beneficiary is the person who'd receive money from your plan if you pass away. You can name one person or several, and you can also decide how to split it up.

A bill submitted by a healthcare provider or by you to an insurance company to request payment for medical services or treatments received.

After you've met your annual deductible, this is your share of the bill. For example, if your plan covers 80%, you'll pay the remaining 20% of the cost of care.

A small set fee you pay when you get care, like $20 for a doctor visit or $10 for a prescription.

This just means you share the cost of care with your insurance company. It includes things like copays, deductibles, and coinsurance—but not what you pay out of your paycheck for coverage.

Your domestic partner is someone you have a committed, intimate relationship with, shares your primary residence, and is at least 18 years old.

This is a list of medicines your plan covers. It's often split into "tiers"—cheaper drugs in lower tiers, pricier ones in higher tiers.

These are the doctors and facilities your plan prefers you to use. They've agreed to lower rates, so you pay less when you go to them.

A healthcare professional or facility that doesn't have a contract with a health insurance plan. Ultimately, using out-of-network providers usually mean you'll pay more out of your pocket when you need care.

This is like your yearly safety net for your health plans. Once you've spent this amount out of pocket on covered services, your insurance takes care of 100% for the rest of the year. You'll only pay the cost per paycheck for coverage.

A 12-month period of benefits coverage under a group health plan. Deductibles, out-of-pocket maximums, and other plan limits reset at the beginning of the plan year. Caliber's health insurance plan year runs from January 1 to December 31.

This means your health insurance plan reviews a service, treatment, prescription, or piece of medical equipment before you get it to decide if it's medically necessary. Your plan might require preauthorization for certain things, but not for emergencies. But just a heads-up, getting preauthorization doesn't automatically mean your plan will cover the cost. It just means the service was reviewed and approved as medically necessary in advance.

What you pay per paycheck for coverage under a health plan. You pay this no matter what to stay covered.

The part of your plan that helps pay for medications prescribed by your doctor. Costs can vary depending on what your medication is.

These are healthcare services aimed at preventing diseases and maintaining health. Caliber's health plans cover a set of specific preventive services at no cost to you.

Your primary care provider is the person who looks after your overall health, coordinates your treatments, and helps you get the care or specialists you need. It might be a doctor, nurse practitioner, physician's assistant or clinical nurse specialist.

Anyone who provides health care, including doctors, nurses, hospitals, lab facilities, clinics and urgent care centers.

This is the typical price doctors in your area charge for a service. Your plan might use it to figure out how much to pay for a service.

A doctor who focuses on a specific area, like a dermatologist for skin or a cardiologist for your heart.

A special kind of medicine that's pricey or needs extra care to handle. They're usually used for long-term or complex health issues.

For when you need quick care—but it's not a life-threatening emergency. Think sprains, bad colds, or small cuts that can't wait for a regular appointment but don't require a visit to the hospital.