Balance Billing
Out-of-network providers may bill patients for the balances remaining on the charges associated
with services rendered, after the insurance reimbursement amount is paid. You are responsible
for the difference between out-of-network billed charges and Aetna’s maximum allowable fee.
Coinsurance
Your share of the costs of a covered healthcare expense calculated as a percent based on the
contracted Aetna rate you pay for services after your deductible is met
Copayment (Copay)
The fixed dollar amount you pay each time you receive certain types of medical services or prescriptions. Copays vary depending on the service you’re receiving.
Deductible
The dollar amount you must pay for covered health care services before your insurance plan
starts to pay. Copayments do not apply to the deductible.
Family
A family plan consists of an employee, a spouse, and at least one dependent child. In all of our plans, once the deductible is met for three members of a family, it is met for all other members of the same family.
Maximum Allowable Fee
An amount determined by Aetna to be the prevailing charge for the service. This amount is based
on a national database, complexity of services, range of services and prevailing charge in the
geographic area.
In-Network
Physicians, hospitals, and other healthcare providers who are contracted with Aetna. Aetna has a national network with providers all over the country. UHealth providers are all within the Aetna network.
Out-of-Network
Physicians, hospitals, and other healthcare providers who are not contracted with Aetna
Out-of-Pocket Maximum
The maximum dollar amount you are required to pay out of pocket for medical, behavioral health
Rx during the calendar year. When the amount of combined covered expenses paid by you
and/or all your covered dependents (family) satisfies the out-of-pocket maximums, the plan will
pay 100% of covered expenses for the remainder of the calendar year. You are still responsible for premiums.
Premium
The amount you'll be deducted each pay period to remain in the plan.
UHealth Provider
A UHealth physician, a UHealth facility, or a Jackson Health System facility.
UHealth Total Care Provider (available as of 1/1/2025)
Primarily UHealth and Jackson Health System providers and facilities; includes access to Aetna network behavioral health and ancillary providers. Review Aetna Doc Find for eligible providers in the UHealth Total Care plan.
Usual, Customary and Reasonable
The usual charge made by a physician or other provider of services that does not exceed the
general level of charges made by other providers for the same care in the same geographic area.
