Confused about your coverage? Don’t be. You can find definitions for US Family Health Plan terms here, helping you understand everything from appeals to premiums.
Appeal: a request asking your health plan to review a ruling on coverage or payment. Learn more about appeals and grievances.
Brand Name Drug: a drug sold under a specific, trademarked brand name.
Claim: a request for payment from your health insurance provider for services, procedures or a drug.
Coinsurance: how health care costs are split with your insurance after your deductible is met.
Copayment: what you pay for a service when you receive it, like a doctor’s office visit or getting a prescription filled.
Deductible: the amount you must pay before your health insurance kicks in.
Dependent: a child or other person who is claimed by another for a personal tax exemption.
Formulary: a list of generic and brand name drugs chosen and covered by a health insurance plan.
Generic Drug: a drug with the same ingredients as a brand name drug but without the trademarked name. Generic drugs are usually covered by a health plan instead of brand name ones.
Grievance: a formal complaint about service and quality of a health plan or provider. Learn more about appeals and grievances.
Maximum Out-of-Pocket: a set amount capping what a member can spend on deductibles, coinsurance and copays for the policy period. After you meet the maximum out-of-pocket, your insurance will cover 100% of expenses.
Premium: a monthly, quarterly or annual amount you pay for health insurance coverage.
Primary Care Provider: the doctor or nurse practitioner that is your main provider of health services.
Qualifying Life Event: a change in your life such as a birth, marriage or divorce that can qualify you for changes to your plan outside of enrollment periods.
US Family Health Plan (USFHP): a TRICARE Prime option available to retirees and their families and active duty dependents residing in a defined service area.
Last Updated: 2/23/17