Health Benefits 101

A percentage of the amount that you and the plan pay for services or prescriptions after you meet any required deductible.

Copayment or Copays
The flat dollar amount that you pay at the time you receive health care services. For example, you may pay a $25 copayment for a physician’s visit.

Coverage Tier
How Sparrow categorizes whom you wish to cover (example: You + Spouse).

The deductible is the dollar amount that you need to pay out-of-pocket before your health care plan begins to pay benefits. (Generally, the larger your deductible, the smaller your premium contribution.)

Evidence of Insurability
Information that must be provided before you can be approved for certain levels of coverage.

Flexible Spending Accounts
Tax advantaged accounts into which you make contributions to pay for eligible health or dependent care expenses, such as deductibles, copayments, over-the-counter items, and some health care services not covered by the health care plan. Sparrow offers a Healthcare Spending Account and a Dependent Care Spending Account.

A group of doctors, hospitals, and pharmacies organized by a health care plan to provide health care services to the members. To get the maximum coverage for the lowest cost, you generally must use the plan’s network. (In a PPO, you have the option to use out-of-network providers, but it will cost you more.)

Caregivers who have medical coverage outside of Sparrow may be eligible to opt-out of Sparrow health insurance and receive a monthly opt-out payment/bonus.

Out-of-Pocket Maximum
The limit on what you have to pay toward eligible expenses in a plan year.  Once you reach the maximum for the period, the plan pays 100 percent for any remaining covered health care expenses, but you are still responsible for charges above reasonable and customary limits for health care this plan doesn’t cover.

Premium (Payroll Deduction)
The dollar amount deducted from your paycheck to pay for your coverage.

Primary Care Physician (PCP)
A primary care physician is doctor who is intended to be your primary doctor and helps to determine when you need to see a specialist.

Primary Coverage
In the event that a Caregiver is covered by an additional insurance plan, Sparrow coverage pays first.

Reasonable and Customary
The amount that the health plan determines is the normal range of payment for a specific health related service or procedure.

Secondary Coverage
In the event that a Caregiver is covered by an additional insurance plan, the insurance plan pays second.

Sparrow Health HSA
A High Deductible Health Plan that features an HSA investment account for Caregivers to contribute tax-free for current and future medical expenses. Contributions to the HSA may be made by the Caregiver, Sparrow, or both. Contributions roll over year to year.

Voluntary Benefits
Voluntary benefits are 100% paid by the employee/Caregiver. Caregivers can choose which voluntary plans are best for their own situation.

Learn more about Health Coverage and Medical Terms

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This is a summary of the benefits provided by each insurance carrier and it is not intended to fully describe the details of each benefit plan. Should any questions arise, the contracts in effect will take precedence.