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SPECIALTY SERVICES

GLOSSARY OF TERMS

Assignment of Benefits (AOBs)

A written approval, signed by you, that gives payment of benefits to the provider of your services (CVS Specialty).

Copayment or Coinsurance

The part of the medical bill you must pay after the insurance company pays their part.

Deductible

A fixed amount that you must pay each policy year. This amount must be met before any benefits will be paid by your insurance company.

Explanation of Benefits (EOBs)

A report that is provided by your insurance company telling you about your medical health insurance claim.

Lifetime Maximum

The maximum amount your insurance company will pay toward claims in your lifetime. Once this maximum has been reached, no benefits will be paid under the terms of the policy.

Medical Review

The process undertaken by your insurance company to review your medical documentation to ensure that the need for therapy meets the coverage requirements of the insurance company.

Out-of-Pocket Maximum

The amount you must pay each policy year before the policy starts paying the full benefits. The out-of-pocket maximum may be for the whole family and/or one person alone.

Payor or Third-Party Payor

An entity (either a private insurance carrier or federal or state program) that administers and is responsible for the payment of health care benefits.

Prior Authorization

Prior authorization is a cost-savings feature of your prescription benefit plan. It helps make sure the right medication is being prescribed under your plan. Your plan may require prior authorization for your medication. If so, the pharmacist and your doctor will discuss if the use of the medication is allowable on your plan.

Reimbursement

A type of payment, usually by a third party, for health care costs.