Helpful Terms

Benefits

The healthcare services your health plan covers: doctor visits, routine physicals, diagnostic tests, etc.

Benefit Period

The stretch of time your plan covers you (for example, July 1 to June 30). See your plan materials for your benefits’ start and end dates.

Contribution

The monthly premium you pay for coverage.

Coinsurance

The percentage you pay for services at a doctor’s office, pharmacy or hospital.

Copay

The set fee you pay each time you use a medical service covered by your plan.

Deductible

The amount you pay before your benefits kick in. Some plans have separate medical and pharmacy deductibles.

Dependents

Children or a spouse covered on your plan.

Formulary

A list of drugs covered by your plan, including generic and brand-name drugs. Log in at hally.com to find your plan’s list of drugs.

Generic Drugs

Drugs with the same active ingredients as the brand-name versions reviewed and approved by the Food and Drug Administration (FDA). They cost less because their makers don’t have to spend money on research, development and marketing.

Member

A person covered under a health plan, either the enrollee or eligible dependent.

Out-of-Pocket Maximum (OOPM)

Your plan pays 100% of covered expenses for the rest of the plan year after you reach this amount. You’ll no longer pay copayments or coinsurance, just your monthly premium.

Prior Authorization

A review process your doctor must request for a specific drug or service to make sure you meet certain requirements before the health plan agrees to cover it. See Page 4 for more information.

Primary Care Provider

A personal doctor (or advanced practice provider) you choose to oversee your care.

Telehealth

Remote healthcare you get from a primary care provider or specialist over the phone or online.

Customer Service

(800) 851-3379 (TTY 711) Weekdays 8 a.m. to 5 p.m. HealthAlliance.org