FAQ

A co-payment (co-pays) is a designated dollar amount paid by the insured to receive specified services. This is payable at the time of service. Some plans require co-pays for doctor visits, prescription drugs and emergency room visits. Co-payments are separate from the deductible amount and normally do not apply toward the annual deductible. Additionally, the deductible does not usually need to be satisfied before a co-payment applies. Please refer to the Summary of Benefits provided by your health plan for specifics of your health plan.

Coinsurance is a cost-sharing requirement under certain health insurance policies. It requires the insured (patient) and the insurer (the employer or health plan) to pay a portion or percentage of the costs for covered services. For example, a plan with an '80/20' coinsurance design would require the employer to pay 80% of the allowable and the patient to pay 20%. Please refer to your plan document for your actual benefit.

The deductible is the amount of money an insured needs to satisfy after making a claim before their insurance company provides benefit coverage. With health insurance, deductibles usually range from $500 to $5,000. So if the insured has a $1,000 deductible, for example, and has a $10,000 claim, he/she will be responsible to pay $1,000 before the insurer starts paying coverage.

The out-of-pocket maximum is a predetermined limited amount of money that an individual must pay out of their own pocket, before an insurance company will pay 100 percent for an individual's health care expenses.

UCR stands for Usual, Customary, and Reasonable – the maximum amount allowed for a covered service based on the following criteria:

• UCR may be limited to the customary charge based on the distribution of charges billed by all providers for a given service within a given specialty and geographic area.
• UCR must also be reasonable to the insurer with respect to customary charges for services of comparable complexity and difficulty.
• The advantage to using QCP providers is that you will not be billed for the balance above UCR, what the insurer allows or pays and the provider bills or charges.

Yes, however your benefits may be reduced as a result which will mean more out-of-pocket expense for you. Because QCP does not pay your claims or have access to information about your benefits and eligibility, contact your insurance company or your claims payor directly regarding how this will apply to your policy. That phone number should be on your insurance card or you may contact your human resource office where you work.

A preferred provider is a prescreened doctor, hospital, or other healthcare provider who has agreed to offer their services at predetermined rates. QCP has developed a comprehensive network to supply you with multiple specialists of medical care.

A physician or other provider has an agreement with QCP to participate in the contracts QCP holds. These providers agree to comply with utilization and quality processes to assist you in coordinating your care.

Costs are lower for covered services in the Network for the following reasons:

• Participating providers agree to negotiated fees or discounts.
• You are not balance billed for the difference between the negotiated fee and the actual charge.
• Your share of the cost for medical service and co-insurance is lower for services rendered in the network because through the discounts QCP has negotiated it will cost your employer less money.

A formulary is a list of brand name and generic medications that have been reviewed and selected by a committee, which is made up of practicing doctors and clinical pharmacists. If your pharmacy benefit includes a formulary, you can save money by encouraging your doctor to prescribe medications from this preferred list.

Brand-name drugs are more expensive than generics because the manufacturers have spent years on research and clinical studies in developing a new medication. As a result, drug manufacturers look to recover some of these research and development costs through drug pricing strategies. Because there are no drug price controls, manufacturers can set the price of their drug at whatever level they want.

However, once a patent on a brand-name drug expires, generic manufacturers may produce an equivalent generic drug. Because generic drug manufacturers are not introducing a new drug, they avoid the related expenses associated with developing a new medication, which is reflected in the lower price.

There are many myths and misconceptions about generic drugs. Some people believe that quality is tied to costs, and that a less expensive product is of lower quality. In the case of generic drugs, that is simply not true.

A generic drug can be produced once the brand-name drug patent has expired. However, the Food and Drug Administration (FDA), which approves brand-name drugs, must also approve all generic drugs before they can be sold. To gain approval by the FDA, a generic drug must:

• Contain the same active ingredients in the same amounts as the brand-name drug.
• Be identical to the brand-name product in dosage form and in the way it is administered. For instance, if a brand-name drug is a tablet taken by mouth, the generic must also be a tablet taken by mouth.
• Have the same uses, cautions, warnings and product labeling as the brand-name drug.
• Have absorption rates that closely match that of the brand-name product. In other words, the time it takes for the body to absorb the generic drug and the amount absorbed at a given time interval must be nearly identical to the brand-name drug.
• Meet batch consistency requirements for identity, strength, purity and quality. Each batch of the generic drug must be identical in every way to all other batches of the generic and brand-name product.

A generic drug must contain the same active ingredients in the same amounts as the brand-name drug. However, the inactive ingredients, as well as the color or shape of a generic drug, may be different from its brand-name counterpart.

Individuals who are experiencing a 'reaction' to a particular generic drug may be allergic or sensitive to these inactive ingredients or dyes. Switching to another product from a different generic manufacturer may relieve the problem.