Medical Plan
Benefits Terms You’ll See During Enrollment
Benefits language can be confusing. Use this page as a quick guide to common terms you may see during Open Enrollment and throughout the year.
What You Pay
Premium / Payroll Deduction
The amount taken from your paycheck to pay for coverage.
Example: If you enroll in medical coverage, your payroll deduction is the amount you pay from each paycheck to keep that coverage active.
Deductible
The amount you pay for certain covered services before the plan starts sharing costs.
Example: If your deductible is $1,500, you may need to pay up to $1,500 for covered services before coinsurance begins. Preventive care is typically covered before you meet the deductible when you use an in-network provider.
Copay
A fixed dollar amount you pay for certain services or prescriptions.
Example: If your primary care visit copay is $35, you pay $35 for that visit. Other services during the same visit, such as lab work, may have separate costs.
Coinsurance
The percentage of covered costs you pay after meeting your deductible.
Example: If your coinsurance is 20%, you pay 20% of the allowed cost and the plan pays 80% after your deductible is met.
Out-of-Pocket Maximum
The most you pay in a calendar year for covered in-network services.
Example: Once you reach your out-of-pocket maximum, the plan pays 100% of covered in-network services for the rest of the plan year. Payroll deductions do not count toward this maximum.
Where You Get Care
In-Network Provider
A doctor, hospital, pharmacy, or facility that contracts with the plan.
Example: Using an in-network provider usually costs less because the provider has agreed to discounted rates with the insurance carrier.
Out-of-Network Provider
A provider that does not contract with the plan.
Example: If you use an out-of-network provider, your costs may be higher, and you may be billed for charges above what the plan allows.
Balance Billing
When an out-of-network provider bills you for the difference between what they charge and what the plan allows.
Example: If a provider charges $500 and the plan allows $300, you may be billed for the remaining $200 if balance billing applies.
Prescription Drug Terms
Formulary
The list of prescription drugs covered by the plan.
Example: Before filling a prescription, you can check the formulary to see whether the medication is covered and what tier it falls into.
Drug Tier
A pricing category for prescription medications. Lower-tier drugs usually cost less, while higher-tier drugs usually cost more.
Example: A generic medication may be Tier 1, while a non-preferred medication or specialty medication may be in a higher tier.
Generic Medication
A medication with the same active ingredient as a brand-name medication.
Example: If your doctor prescribes a brand-name medication, you may want to ask whether a lower-cost generic option is available.
Understanding these terms can help you compare your options, estimate your costs, and use your benefits more confidently. For exact plan details, review your official benefit guide, plan documents, and UKG elections, or contact the Benefit Resource Center.
Enrollment Terms
Evidence of Insurability
A health questionnaire that may be required when applying for certain voluntary benefits, such as voluntary life insurance.
Example: If you request coverage above a guaranteed issue amount or apply after your initial enrollment period, you may need to complete Evidence of Insurability before coverage is approved.
Enrollment Terms
Qualifying Event
A life change that may allow you to update your benefits outside of Open Enrollment.
Example: Marriage, divorce, birth or adoption of a child, or loss of other coverage may allow you to make certain benefit changes during the year.
Your Two Medical Plan Options
MLF offers two Anthem Blue Cross Blue Shield medical plans through the Blue Access® network. Both cover preventive care, hospital visits, doctor visits, and prescriptions. The key difference is how you pay.
Traditional Plan (Premium Plan)
Higher paycheck deduction, lower out-of-pocket costs at time of service. Copays apply for office visits and prescriptions. Eligible for a Health FSA. Not eligible for an HSA.
HDHP Plan (Budget Plan)
Lower paycheck deduction, higher out-of-pocket costs until deductible is met. No copays — you pay full cost until deductible is reached. Eligible for a Health Savings Account (HSA) with MLF match.
Contact: Anthem / Blue Cross Blue Shield | Group #W12978 | (800) 295-4119 | www.anthem.com
Before you choose a medical plan
Review:
- Your payroll deduction in UKG
- Your expected doctor visits
- Your regular prescriptions
- Any planned procedures, imaging, lab work, or specialist visits
- Whether you are covering dependents
- Whether you want access to an HSA
- The plan’s deductible and out-of-pocket maximum
- Whether your providers are in-network
Helpful tools
* Use Anthem tools to estimate costs when available.
* Use FairHealthConsumer.org for general cost estimates.
* Use GoodRx for retail prescription cost estimates. GoodRx estimates do not account for Anthem discounts or negotiated rates.
Medicare Questions & Support
Medicare can be confusing, especially if you or a covered family member are approaching age 65, retiring, or trying to understand Medicare coverage options.
Gallagher offers access to Medicare advisors who can help Medicare-eligible employees and retirees review coverage options. This resource is provided through Gallagher’s Alternative Health Solutions Medicare advisors.
They can help you understand Medicare basics, compare coverage options, and review plans that may fit your needs and budget.
How to Find Your Benefit documents
Looking for benefit documents?
Log in to UKG, then go to Benefits > Manage My Benefits > Documents to view available benefit guides, plan summaries, notices, and related materials.
Need help?
This page is a general overview. Your exact benefits, costs, coverage start dates, and eligibility rules may depend on your employee group, plan election, coverage level, and pay frequency. It is your responsibility to review your benefits, coverage elections, and covered dependents. Review your official benefit guide or highlight document, confirm your elections in UKG, or contact the Benefit Resource Center for help.
Medical Coverage