Terms to Know

The benefit plan year is from January 1 to December 31. If you’re a new hire, your plan year starts on the date your benefits become effective and lasts until December 31.

This is the percentage of the cost your health plan pays for services after you have met the deductible. For example, your plan may pay 80% of your costs, and you would be responsible for the remaining 20%.

This is a dollar amount you pay when you receive certain care, such as when you visit the doctor or get a prescription filled. An office visit copayment is less expensive than an emergency room copayment.

The amount you pay out of pocket each plan year for your health care before your plan pays any benefits. In high-deductible health plans (HDHPs), the deductible is for medical and prescription drugs combined. Once you meet your deductible in the HDHPs, you pay the coinsurance amount for your prescriptions.

A formulary is a list of drugs that are determined and maintained by your prescription provider and are covered under their prescription drug programs. The formulary is designed to help health care providers prescribe drugs that are medically necessary for your treatment and are cost-effective.

In-network providers are health care providers that are contracted with your medical plan provider and have agreed to certain health care rates. Because of this, you’ll pay less for services when you use an in-network provider rather than an out-of-network provider.

Your lifetime benefit is the cumulative dollar amount that your plan will pay for the life of the enrollee or the existence of the plan.

These are medications used to treat chronic conditions and long-term conditions. For example, medications taken to lower blood pressure or cholesterol are considered maintenance medications.

Health insurance provides valuable financial protection but does not cover all your expenses, like copayments, deductibles and coinsurance. It’s helpful to be familiar with these costs so that you can make an educated decision when you choose a health plan.

Out-of-network providers are health care providers that are not contracted with your medical plan provider and have not agreed to certain health care rates. Because of this, you’ll likely pay more for services if you use an out-of-network provider instead of an in-network provider.

The maximum amount you’ll pay in a plan year. Depending on the medical plan you elect, there may be separate out-of-pocket maximums for medical and prescription drug expenses. In the HDHPs, there is only one combined out-of-pocket amount for both medical and prescription drug expenses. After you meet your out-of-pocket maximum, your plan will pay 100% of your eligible expenses for the remainder of the plan year.

Your paycheck premiums are the weekly or biweekly amounts you pay to be enrolled in your benefits.

Drug tiers are how medications are classified by Optum Rx. Tier 1 drugs meet the same standards for safety, purity, strength and quality as Tier 2 or Tier 3 drugs. If you choose a Tier 1 drug, you will pay the lowest copayment amount, while Tier 3 prescriptions usually have the highest copayment amount.

In the HDHPs, the deductible is for medical and prescription drugs combined. Once you meet your deductible, you only pay the coinsurance amount for your prescriptions.

Preventive care is health care measures taken to prevent diseases.

For example, your annual physical is considered preventive care. During your annual physical, your health care provider will conduct a biometric screening, such as a blood pressure exam and laboratory tests, to give you a clearer picture of your overall health. These tests can detect and alert you of potential health conditions, such as diabetes, high blood pressure and heart disease.

Through preventive care, you can identify any health risks early and get ahead of them before they become more serious.

This is a requirement that your doctor or pharmacist must get approval from your health plan before you receive certain tests, procedures or medications. Without this approval, your plan may not cover the cost for your medical service or medication.

Qualifying life events are occasions — like a birth, an adoption or a marriage — that change your or your dependent’s eligibility for benefits. You have the opportunity to make changes to your benefits within 31 days after the qualifying life event.

When prescription drugs are needed to treat a medical condition, step therapy requires you to start with the most cost-effective and safe option. If that medication doesn’t work, other medications may be an option.

The U&C limit is the maximum amount certain medical plan options and dental programs pay for all services. U&C limits are based on commonly charged fees — “the going rate” — for medical or dental services in a geographic area. Amounts over U&C are the responsibility of the employee and do not count toward a plan’s out-of-pocket maximum.

A matching contribution is the amount of money Republic Services adds to your 401(k) Savings Plan based on how much you contribute. On the first 3% of pay you contribute, Republic Services will match your contributions dollar for dollar. For the next 2% you contribute, Republic Services will match 50 cents on the dollar.

Health and welfare plans are employer-sponsored programs that provide financial protection and support for your health and well-being. They typically include coverage for medical, dental, vision, mental health, disability, and life insurance, helping you manage health care costs and maintain financial stability during unexpected life events.

A retirement plan is a way to save money for your future after you stop working.

Common types of retirement plans include 401(k) savings plans, which often come with tax advantages.