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Vanderbilt Group Health Plan Glossary of Terms

Also see the Glossary of Health Coverage and Medical Terms


 

Co-insurance

You and Vanderbilt share the cost of a covered expense (after you meet the deductible). For example, if the health plan pays 80% of a covered expense, the 20% remaining to be paid is your co-insurance amount.

Co-pay

The set amount you pay out-of-pocket for a doctor's or facility visit or a prescription. For example, your co-payment could be $20 for a doctor's visit. The co-pay does not always cover the entire cost of the service, if tests were performed that are billed separately.

Deductible

A flat amount you must pay before the health plan starts paying.

Formulary

A list of prescription drugs covered by the health plan.

Generic Drug

A prescription drug that has the same active-ingredient formula as a brand name drug. Generic drugs cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs.

Health Reimbursement Account

A Health Reimbursement Account is an employer-paid benefit account offered to employees. Vanderbilt has two types of Health Reimbursement Accounts.

  1. The Health Reimbursement Account for faculty and staff whose employment began on or before December 31, 2004. Vanderbilt deposits $25 per month ($300 annually) into an account for each eligible faculty and staff member starting with the first month in which they become eligible. To access the money in this HRA, you either use the PayFlex debit card or pay for the item/service at the point of purchase then submit a claim form and required documentation to PayFlex.
  2. The Health Reimbursement Account funded by your Go for the Gold Wellness Credit. Employees who complete all or part of the Go for the Gold wellness program and who elect to enroll in the Vanderbilt Group Health Care Plan for Faculty and Staff receive the Wellness Credit. Faculty and staff who waive the health plan are not eligible to receive the Wellness Credit. This Health Reimbursement Account is built into your health plan and helps pay your deductible and co-insurance amounts. You do not have to place claims on this account, Aetna or BlueCross automatically pay claims from this account for you.

For both types of Health Reimbursement Accounts, unused funds are carried over from year to year.

Health Risk Assessment

A form or online tool that is completed by employees to assess an individual's current health status, as well as risk factors for future illness. Vanderbilt's Health Risk Assessment is the first step in the Go for the Gold wellness program.

Out-of-Pocket Limit

The most you pay yearly for co-insurance (includes your deductible in the HealthFund option). Co-pays do not help you meet the out-of-pocket limit.

 


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