b'TerminologyAnnual Plan Deductible In-Network MedPayThe amount of covered medical expensesPhysicians and hospitals that agree toCTPFs program that pays Medicare Parts a member pays per calendar year before aaccept an insurance providers terms A, B, & IRMAA Part B for enrolled membershealth plan covers services.and payments.who must pay for both Medicare Parts A Annual Maximum and B.The amount a member pays out-of-pocketIRMAA Open Enrollmentfor benefits each year.Income-Related Monthly Adjustment Amount (IRMAA). The period when annuitants can enroll in An additional amount that must be paida health insurance plan for the first time, Annual Maximum for Medicare Part B and Part D bychange health insurance plans, or add The amount a member pays out-of-pocketMedicare beneficiaries who havedependents to a health insurance plan.for benefits each year.higher incomes. Out-of-NetworkAnnuitant Lifetime Reserve Days Physicians and hospitals who do not accept An individual entitled to collect a pensionAdditional days that Medicare will pay fora health insurance providers terms and or annuity payment. An annuitant mayhospitalization longer than 90 days. A totalpayments. Charges are usually higher than be the retiree or a survivor receiving a of 60 reserve days can be used during ain-network providers.pension payment. lifetime. Medicare pays all covered costsOut-of-Pocket Maximumexcept for daily coinsurance for reserve Coinsurance days. The maximum amount paid out-of-pocket The set amount a member pays (usually afor covered expenses in any plan year. percentage) for services before a plan beginsMedicare (Original) After the out-of-pocket maximum is met, to pay.the plan pays at 100% of the eligible Original Medicare consists of Part A andcharge or the Usual and Customary Part B. It is run by the federal government.charge as determined by the health plan Copayment/Copay Medicare pays hospitals and doctorsadministrator. The set amount a member pays for adirectly for your care. Medicare pays some medical service.but not all of the cost of your care.PremiumPeriodic payment to Medicare, an Creditable Coverage Medicare Advantage insurance carrier, or health care plan to Medicare Advantage plans are also knownmaintain health care or prescription drug Prescription drug coverage that is onas Medicare Part C. Medicare Advantagecoverage. average at least good as if not better thanplans combine the services of Part A and the standard Medicare Part D prescriptionPart B, and often times, Part D. Primary Care Physician (PCP)drug coverage.A physician responsible for a members Medicare Part D complete health care services. A PCP can Deductible Medicare Part D is prescription drugmake referrals to specialists andThe amount a member pays for servicescoverage offered by private insuranceother health care providersfor health insurance before the insurancecompanies. The federal government sets afor services. carrier will cover the cost of services. minimum standard of prescription benefitsReferralthat must be covered by Part D plans.A written order required from a PCP that Effective Date allows a visit to a specialist or to obtain The first day health insurance coverageMedigap certain services. begins. Insurance coverage offered by private companies that helps pay the costs thatSpecial DeductibleEmergency Medical Care Original Medicare (Parts A and B) doesntEmergency room deductible and non-PPO Medical care provided in a hospitalcover, such as Part A and B deductibles andadmission deductible. These deductibles emergency room.coinsurance. Original Medicare providesare in addition to the annual plan year coverage first, then Medigap helps fill indeductible.the gaps. The federal government defines Formulary standard benefits for Medigap plans. A list of preferred drugs approved for usePremiums may vary between healthUrgent Medical Careby a health insurance plan. insurance companies offering MedigapMedical care provided in an urgent care plans for identical coverage. Medigapfacility.premiums are regulated by each state.CTPF 2021 HEALTH INSURANCE HANDBOOKCTPF 2021 HEALTH INSURANCE HANDBOOK45'