Health Plan Terms

Contribution: The monthly amount you pay for health plan coverage.

Covered Service: A service or supply that is part of the health plan.

Deductible: How much you must pay for covered services before the health plan pays.

Co-pay: The amount you pay for covered services each time you visit a provider or facility. While the co-pay doesn’t apply to your deductible, it does apply to the out-of-pocket maximum.

Co-insurance: The percentage you must pay for care after you’ve met your deductible.

Out-of-pocket maximum: The absolute maximum you’ll pay annually. Once you meet the maximum, the health plan pays 100 percent of covered services with in-network providers and facilities.

Biometric screenings: Biometric screenings measure total cholesterol and HDL cholesterol, glucose, blood pressure, height and weight, and BMI (body mass index). Participants may choose optional screenings for LDL and triglycerides (8- to 12-hour fast required) and body composition/percent body fat.

The free, confidential biometric screenings and wellness assessments are part of Adventist Health’s commitment to supporting employees and their families in achieving optimal physical, mental and spiritual health and wellbeing.

Adventist Health’s employee health plan covers preventative services at 100 percent. You will pay no deductible, co-pay or co-insurance for these services. Find expanded definitions and a list of preventative services in the Summary Plan Descriptions.