CDHP Consumer-driven health plan, a type of medical insurance or plan that generally has
a higher deductible and lower monthly premiums. Typically, you take responsibility
for covering your health care expenses until your deductible is met. Once you meet
your deductible, coinsurance applies up to the out-of-pocket maximum.
Coinsurance Some services require that you pay coinsurance. Coinsurance is a percentage of the
Deductible All options include an annual deductible. You pay this amount out of pocket before
the plan pays for most services that require coinsurance.
Cost Sharing The share of costs not covered by your insurance that you pay out of your own pocket.
Copay Some services require that you pay a copay. A copay is a flat dollar amount, like
$25 for a doctor's visit.
Network A group of doctors, hospitals, facilities and other healthcare providers contracted
with a health insurance carrier to provide services to plan members for set fees.
Out-of-Pocket Maximum The out-of-pocket maximum is the most you will pay for your copays, dedutible and
coinsurance each year. Once you reach your out-of-pocket maximum, the plan pays 100%
of covered medical expenses.
In-Network vs. Out-of-Network Providers You can see any doctor or go to any healthcare facility you want. However, if you
use an "in-network" provider, you will always pay less. That's because an in-network
provider agrees to provide services at discounted rates.
Plan The State of Tennessee Group Insurance Program, including state-sponsored PPO and
CDHP/HSA plan options. The plan provides or pays a portion of the cost of medical
care and determines how much you pay in premiums, copays and coinsurance.
PPO Preferred provider organization, gives plan participants access to a network of doctors
and facilities that charge pre-negotiated (and typically discounted) fees for the
services they provide to members. The benefit level covered through the plan depends
on whether the member visits an in-network or out-of-network provider when seeking