Many terms are used throughout the SEGIP website and information materials. Some of them are familiar, but others might be new to you or your family members. Use the following glossary of terms to understand what a term means.
Advantage Value for Diabetes (AVD) helps SEGIP Minnesota Advantage Health Plan Members diagnosed with diabetes have access to reduced out-of-pocket costs for high-value medical services that are primarily for diabetes. Eligible medical services include physician office visits, dietitian office visits, diabetic retinal eye exams, lab tests, diabetic testing supplies and pharmacist consults.
Benefits are for care through your primary care clinic or referred in-network provider. All care not primarily related to diabetes will be covered under the standard plan benefits. CVS Caremark formulary medications for diabetes, hypertension, cholesterol, and depression drugs as well as diabetic test strips are covered under AVD. Members should call their health plan administrator (Blue Cross Blue Shield of Minnesota or HealthPartners) or CVS Caremark to determine where to purchase equipment or testing supplies and what is covered through the medical benefit.
Members aged 18 or older (whether active participant, dependent, early retiree, or former employee who has continued coverage (FEWD, COBRA) will receive discounts without the need to enroll. Please visit the AVD webpage for the most up-to-date information for more details about the plan including the list for eligible drugs and Frequently Asked Questions.
A document available to plan participants describing details of coverage. Insured plans call this a certificate of coverage and self-insured plans call this a summary of benefits.
The acronym COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. This act is a federal law that gives you and your dependents the right to temporarily continue medical, dental, and certain life insurance coverages, at your own expense, when you experience an event that causes you to lose coverage. To learn more, visit the COBRA page.
This is a percentage of the cost that is charged for certain services after the deductible has been paid. For example, a coinsurance level of 90% means that the member first pays the deductible, then the plan would pay 90% of the costs and the member would pay the remaining 10% of the costs.
A flat dollar amount that is charged every time a service is provided. For example, under the Minnesota Advantage Health Plan (Advantage), members will be charged an office visit copay for most visits to the doctor's office. Copays will not be charged under Advantage for preventive care, such as immunizations, annual check-ups, etc.
Cost level determines the amount that you will pay for your copay and deductible, depending on which primary care clinic you choose. Each primary care clinic is assigned a certain cost level. This cost level is negotiated between the clinic and the health plan and does not reflect the level of care that you will receive at that clinic. By choosing a primary care clinic with a lower cost level you will have a smaller copay and deductible.
You may change your primary care clinic at any time during the year. If you are enrolled in family coverage your copay and deductible are determined by the highest cost level of any member of your family.
Prescription drug coverage that is on average at least as good as the standard Medicare prescription drug coverage.
A dollar amount that must be paid each year before the plan starts paying for services. For example, a $250 deductible means that a member would pay the first $250 per year for certain services before the plan would begin covering the cost of services.
For SEGIP's purposes, a dependent is anyone who is eligible to be enrolled on your insurance coverages. This can be your:
and in some cases, your:
For more information, visit our Family Eligibility page.
The date on which an insurance policy or plan goes into effect and coverage begins.
Medical expenses or other charges that a health plan will provide benefits for. Some health providers may charge more than what an insurance plan considers eligible. In these cases, the covered person is responsible for paying the additional costs.
A drug formulary is a listing of preferred high-quality, cost-effective drugs selected by a professional committee of physicians and pharmacists.
A drug that has been on the market long enough that no single manufacturer has an exclusive right on making and marketing.
The group of health care providers with whom a plan has contracted to provide services to members of the plan. Networks may change during the year, so ask if a provider is still participating with your plan before you seek services.
The federal government's plan for paying certain hospital and medical expenses for those individuals who qualify and are enrolled in the Medicare plan, primarily those age 65 and over. Benefits are provided regardless of income level. The program is government-subsidized and government-operated.
Medicare Part A, hospital insurance, pays for inpatient hospital services and post-hospital care.
Medicare Part B, Supplementary Medical Insurance, pays for medically necessary doctors' services, outpatient hospital services, and other medical services and supplies not covered by part A.
Medicare Part D pays for prescription drug coverage for qualified Medicare beneficiaries.
Open Enrollment is your opportunity to change your benefit elections for the upcoming calendar year. Open enrollment usually takes place in the Fall each year.
Fees and charges that an insured person is required to pay for products or services.
Treatment that does not require hospitalization.
