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Provider: A licensed person (doctor) or facility (hospital, urgent care center, lab, etc.) that provides health care. Network providers are those who have accepted the pay rate offered by Cigna. Out-of-Network providers include all others who have refused the Cigna pay rate or those who have not been asked to accept that rate.

Copayment (copay): What the employee or covered dependant pays at the doctor’s office or other providers’ facilities each visit. Copayments are a cost sharing arrangement in which the employee and dependants pay a specific charge for physician office visits, prescriptions or ER services.

Deductible: The money an individual or family must pay from their own funds toward covered medical expenses each year. After that, the Plan begins to pay toward the cost of covered health care services. For example, the Oberlin College Plan has a $250 deductible for single and $500 deductible for family (in-network). The deductible is met once the first $250/$500 of the covered medical expenses for that year have been paid out of pocket by the individual or family.

Out-of-Pocket Maximum: The most money the employee or dependant would be required to pay from their own funds toward covered medical expenses each calendar year, before the Plan will pay 100 percent of the member’s health care expense for the remainder of that calendar year. For example, the Oberlin College Plan has a yearly maximum out-of-pocket of $1,500 for single and $3,000 for family. The annual deductible is included in the Out-of-Pocket Maximum.

In-Network: Refers to the use of doctors, specialists, or therapists who participate in the Health Plan's provider network. Oberlin College Health Plan members are encouraged to use participating (in-network) providers to reduce their out-of-pocket expense.