| A | B |
|---|
| Co-pay | flat amount EE pays at every medical visit |
| Deductible | pre-set annual amount EE pays before carrier begins to pay |
| Co-insurance | based on percentage, amount EE must pay |
| Out of pocket maximum | most EE will pay each year |
| Lifetime maximum | total amount carrier will pay for EE over his lifetime |
| Reasonable & Customary | prevailing rate in geographic area |
| Primary Care Physician | in-network doctor in managed care plan |
| Emergency care | immediate care to save EE's life |
| Urgent care | immediate care to prevent deterioration of health |
| Pre-certification | prior approval for surgery or hospitalization |
| Health Maintenance Organization | managed care w/ in-network benefits only |
| Point of Service | PCP in-network but not out-of-networ |
| Preferred Provider Organization | lower costs in-network & higher costs out-of-network |
| Indemnity plan | traditional health plan w/ most choice & costs |
