Alternative Benefit:
Some employers offer an incentive for their employees not to enroll in their health and/or dental insurance plan(s). If a school district does this, it is commonly an extra cash payment for not enrolling (some districts might offer an employer-paid Tax Sheltered Annuity payment). Your spouse's employer might offer cash or some other benefit, like extra vacation pay, etc.

If either employer offers an alternative benefit for not enrolling in the employer's plan(s), you need to weigh this extra benefit against any insurance benefits you might lose for not enrolling, such as a higher deductible, freedom to see the doctor of your choice, coverage for specific conditions like chiropractic services or prescription drugs, etc. See the Compare Plans section.

If you decide not to enroll in your district's plan because you have coverage through your spouse's insurance, you should be aware that you have the right to enroll later if you have a qualifying event.

Coinsurance:
The percentage paid by the plan after the deductible has been met. 90% coinsurance means the plan pays 90% while you would pay the other 10%. There is usually a stop-loss to your percentage. For example, you pay 10% of the first $5,000, the play pays 100% after that.

Copayment:
The $ amount you pay for prescription drugs. Some health plans also require a copayment for office visits and emergency room visits.

Deductible:
Yearly, out-of-pocket expense before your insurance kicks in. The most common is $100 for single and $200 for family.

Medical Necessity:
Medical necessity refers to whether a medical procedure or service is required for your treatment. Just because a doctor or other health care professional recommends or performs the treatment doesn't mean it is necessary for your treatment. Note: Many beneficial health care services are recommended by physicians but are not medically necessary. Common examples are weight loss or tobacco cessation programs.

Plan:
There may be several different plan types available. To see what different plan types include click on the plan type link.

Preauthorization:
Services which need preapproval by the insurance company. A common requirement is to call prior to hospital admission. Failure to do so can result in penalties.

Preferred Provider/Network:
Medical providers within a plan who offer exclusive coverage or have agreed to discounted fees, i.e., no UCR cutbacks.

Premium:
The cost of the health plan. In many schools this is district paid; in others, employees must pay some of the cost.

Qualifying Event:
An event such as the involuntary loss of your spouse's plan (layoff, job change, divorce, etc.), or the birth or adoption of a child.

UCR or U&C:
Insurance companies pay what they consider to be usual, customary, and reasonasble charges. Individuals may be responsible for the balance.