KNOW YOUR BENEFITS • Medically Necessary (or medical necessity)—Services or supplies provided by a hospital, health care facility or physician that meet the following criteria: (1) are appropriate for the symptoms and diagnosis and/or treatment of the condition, illness, disease or injury; (2) serve to provide diagnosis or direct care and/or treatment of the condition, illness, disease or injury; (3) are in accordance with standards of good medical practice; (4) are not primarily serving as convenience; and (5) are considered the most appropriate care available. • Medicare—An insurance program administered by the federal government to provide health coverage to individuals aged 65 and older, or who have certain disabilities or illnesses. • Out-of-pocket Expense—Amount that you must pay toward the cost of health care services. This includes deductibles, copayments and coinsurance. • Out-of-pocket Maximum (OOPM)—The highest out-of-pocket amount paid for covered services during a benefit period. • Premium—The amount you pay for a health plan in exchange for coverage. • Preventive Care—Routine health care, including screenings, check-ups, and patient counseling, to prevent or discover illness, disease, or other health problems. Covered 100% In Network and not subject to deductible. • Primary Care Physician (PCP)—A doctor that is selected to coordinate treatment under your health plan. This generally includes family practice physicians, general practitioners, internists, pediatricians, etc. Open Enrollment Glossary of Terms (Continued)