Common Healthcare Coverage Terms

Learn these definitions to better understand your insurance plan.

Co-insurance is the percentage of costs you pay for medical services after you have met your deductible (if your plan has one).

A co-pay is the amount you pay for doctor’s visits, emergency room visits and often for prescriptions. Some plans require you to pay co-pays instead of meeting a deductible. Other plans may require you to do both. Your co-pays do not count toward the deductible amount, but do count toward your out-of-pocket limit.

Premium is the full cost of your health coverage every month. The co-premium is a percentage or set amount of your total health coverage that you pay. For example, the co-premium for your personal coverage is just $25 a month. However, if you choose to enroll dependents in coverage, your monthly co-premium will be higher.

The deductible is the amount you pay during a coverage period (usually one year) for covered healthcare services before your plan begins to pay. The deductible may not apply to all services and not all plans have a deductible. For some plans, the deductible may only apply to out-of-network services.

A dependent is a child (through their 26th birthday) who is eligible for coverage on your plan through SEIU 775 Benefits Group. See a full list of qualified dependents.

You are eligible for personal health coverage with SEIU 775 Benefits Group after you work for a minimum of 80 paid hours per month for at least two months in a row. To stay eligible for your coverage, you must continue to work 80 hours per month. 

In-network services are services that your health plan covers, and you can get at a lower or no co-pay/co-insurance. Out-of-network services are those that may or may not still be covered by your plan, but may have a higher co-pay or co-insurance than in-network services.

Your member ID is a unique number connected to you that allows healthcare providers and their staff to verify your coverage and arrange payment for services. It’s also the number health insurance companies use to look up specific members. Your member ID number can be found on your member ID card.

Your network is made up of the facilities, providers (doctors, nurses) and suppliers your health plan has contracts with to provide health care services.

The out-of-pocket limit is the total you must pay for before your plan begins paying 100% of covered health costs for the rest of the year. Generally, co-pays, your deductible, co-insurance and covered in-network payments count toward this limit.

A primary care provider is a doctor or other healthcare provider, like a nurse or a physician’s assistant, that you can see for continued care. You can choose your primary care provider through your health plan’s website. Some plans may assign one to you, but you can change it at any time.

An inpatient service is one that requires you to stay at a hospital or medical facility overnight. Some examples may be delivering a baby or some surgeries. An outpatient service is any service that does not require you to stay at a hospital or medical facility.

If you do not want to enroll in health coverage or would like to end coverage for you or your dependent(s) (if enrolled), you can fill out an online form on Health: My Plan or call Customer Service to get a paper form. If you choose to waive coverage, you may not be able to enroll again until the next Open Enrollment period (every year July 1-20), or you have a Qualifying Life Event.

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Caregiver Learning Center System Maintenance

June 6 (Thursday) – June 10 (Monday)

You can log in, enroll and take your training in the Caregiver Learning Center during this time. 

If you complete training during the System Maintenance, it will be sent to your employer after June 10. 

Please contact your employer if you have questions about your training requirement, deadline or payment.