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We get it. Insurance jargon is complicated. So we’ve put together this guide to demystify common insurance terms, providing clear and concise definitions to help you deepen your understanding and more clearly see the disparities in how Wisconsin’s educators pay for health care coverage.
Annual Total Family Plan Premium
The annual amount that must be paid for your health insurance or plan.
Employee Family Plan Premium Portion
The portion of the annual family plan premium paid for by the employee.
Gross salary
Gross salary is the earned wages before any payroll deductions for federal, state, Social Security, Medicare taxes; insurance premium deductions, etc.
Deductible
A fixed amount of money you must pay out-of-pocket for covered medical expenses during a coverage period (usually one year) before your insurance plan begins to pay. An overall deductible applies to all or almost all covered items and services. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered healthcare services subject to the deductible. A plan with an overall deductible may also have separate deductibles that apply to specific services or groups of services like prescription drugs, out-of-network care, or if you have a family plan where each individual has their own deductible alongside a family deductible.
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MOOP
MOOP stands for "maximum out-of-pocket" and may be referred to as Out-of-Pocket Maximum or Annual Out-of-Pocket Maximum. It is a limit on the amount a person pays for covered medical services during a coverage period (usually one year). This limit never includes your premium, balance-billed charges, cost of prescriptions or health care your plan doesn’t cover. Some plans don’t count all of your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. Once a person reaches their MOOP, their health plan pays 100% of covered costs for the rest of the year.
Family Plan Deductible + MOOP
The total cost of healthcare an individual or family must pay out-of-pocket for covered medical expenses during a coverage period (usually one year). This cost DOES NOT include premium, balance-billed charges, cost of prescriptions or health care your plan doesn’t cover.