Glossary

Brand-Name Drug - A prescription drug protected by trademark registration.

Coinsurance - A percentage of a covered expense; also, your share of a covered expense. For example, if the plan pays benefits at 80%, your coinsurance is 20%.

Copay/Copayment - A flat fee you pay for certain covered services, which represents a portion of the actual expense to the plan.

Deductible - The amount of your covered expenses you pay out of your own pocket before the plan starts to pay benefits.

Emergency - A recent and severe medical condition - including but not limited to severe pain - which would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to get immediate medical care could result in:

  • Placing the person's health in serious jeopardy; or
  • Serious impairment to bodily function; or
  • Serious dysfunction of a body part or organ; or
  • Serious jeopardy to the health of the fetus (in the case of a pregnant woman).

Formulary - A list of prescription drugs that have been evaluated and selected by CVS Caremark clinical pharmacists for their therapeutic equivalency and efficacy. The formulary is periodically reviewed and modified by CVS Caremark.

Generic Drug - A prescription drug that is not protected by trademark registration, but is produced and sold under the chemical formulation name.

Health Savings Account (HSA) – A tax advantaged account which MITRE will help fund for you. The account may be used to pay for qualified health-related expenses (such as deductibles, coinsurance and copays). The HSA allows you the choice of using the money to pay for current out-of- pocket health-related expenses or to build the account and use it for future health-related expenses. In accordance with IRS regulations, a Health Savings Account is only available to employees who are not:

  • Enrolled in Medicare, Medicaid or TRICARE.
  • Covered by another health plan other than an HDHP.
  • Eligible for reimbursement of medical expenses on your or someone else’s standard Flexible Spending Account ( FSA)
  • Claimed as a dependent on someone else’s Federal tax return.

In-Network Provider A doctor, hospital or other health care provider that belongs to Aetna's network.

Out-of-Network Provider A doctor, hospital or other health care provider that does not belong to Aetna's network.