Terms & Concepts

This is the maximum amount your medical plan will consider when processing an eligible claim from your out-of-network healthcare provider – doctor, hospital, lab, or other provider. If the provider's actual charges are higher than the maximum Allowable Amount, any portion above the maximum Allowable Amount will be excluded from coverage. When you use an out-of-network provider, you are responsible for the difference between the plan’s maximum Allowable Amount and the provider's actual charges in addition to any applicable deductible and coinsurance amounts.

NOTE: The charges that exceed the maximum Allowable Amount do not count toward your annual deductible or out-of-pocket maximum. For UBS's Core and Core Plus medical plans, the maximum Allowable Amount is set at 300% of what Medicare would pay for the applicable service.

NOTE: This threshold applies to out-of-network services and facilities only. You can avoid significant out-of-pocket expenses by choosing in-network providers and facilities. Before using an out-of-network provider and incurring significant out of pocket expenses, we strongly advise you to call your medical carrier to determine if the amount you will be charged is equal to or less than the maximum Allowable Amount. When calling, you will need to have:

• The CPT4 codes that apply to the services being performed
• The ZIP code that corresponds to where the service will be performed
• The name of the facility where the service will be performed

The amount that you pay each year out of pocket for non-preventive services and non-preventive drugs before the plan steps in to pay any of the costs.

In our Core and Core Plus plans, there is one in-network deductible. All in-network spending goes against this deductible, including pharmacy (prescription drugs), medical office visits, specialists, lab work, urgent care or hospital stay costs.

• There is no separate deductible for prescription drugs.
• There is no separate deductible for family members. Just one annual deductible across the entire family that must be met before coinsurance begins. 

NOTE: Out of network costs are separate and do not count toward your in-network deductible

For purposes of the plan, your Benefits Base Salary is defined as your gross cash eligible earnings prior to any pre-tax deductions, as determined by the plan administrator in its sole discretion. Generally, eligible earnings are (as applicable):

• your salary
• the cash portion of any discretionary annual bonus
• overtime
• production / commissions

This could also include, (as applicable) additional cash compensation, and some types of recurring cash awards and supplemental payments such as FA paid supplemental compensation, and Year End Supplemental Compensation.

Eligible earnings do not include, without limitation, the following:

• Any non-cash compensation (including, but not limited to, restricted stock and any awards under UBS deferred compensation plans, whether or not paid in cash);
• All non-recurring compensation (including, but not limited to, the amounts realized on the exercise of stock options, cash versus stock, capital contribution payments, employee transition bonus payments/Employee Forgivable Loans, and prizes and awards)
• Payments from the UBS PartnerPlus Plan and UBS Deferred Award Plan

BBS is calculated using a 12-month look back method from August 31^st and becomes effective for the new plan year on January 1^st, and will remain constant for the entire calendar year regardless of any changes in your compensation.

What is BBS used for? Benefits Base Salary (BBS) is used to determine:

• Health plan premiums
• Annual deductibles
• Annual out-of-pocket maximums
• Eligibility for Dependent Care FSA company match
• UBS's contributions to a Health Savings Account (if applicable)
• Basic and Supplemental Life Insurance coverage level

Long-Term Disability (LTD) BBS is determined by averaging the BBS from the prior two years.

• For purposes of your health and welfare plans, eligible dependents include your:
• Spouse or Civil Union Partner (opposite-sex/same-sex), unless you are divorced
• Domestic Partner (opposite-sex/same-sex), provided all requirements are met
• Children (including stepchildren, adopted children, foster children, children of your domestic partner) up to the end of the year (or the end of the day or month if required by the carrier) in which they turn age 26
• Children of any age who are dependent on you for support due to physical or mental disability (subject to certain restrictions)

Covering ineligible dependents in your healthcare plans is a violation of UBS policy. If UBS determines that you are covering ineligible dependents, you can and will be subject to discipline, including possible termination of employment. Please refer to the Eligibility & Enrollment page on the Alight Worklife website for more information.

Out-of-network coverage is available under both the Core and Core Plus plan options (except if you opt for Kaiser which requires you to use Kaiser's network, unless you require emergency medical services).

NOTE: You will pay significantly more when you opt for out-of-network providers. Here's why:

• Generally, covered expenses from in-network providers will be reimbursed at a higher level than those from out-of-network providers.
• Once you have meet the separate out-of-network annual deductible, the plan pays 60% of the Maximum Allowable Amount for out-of-network services, which is set at 300% of the Medicare fee schedule.
• All amounts charged by out-of-network providers that exceed the plan’s Maximum Allowable Amount are your responsibility and do not count toward your annual deductible or out-of-pocket maximum. Read the Allowable Amount definition in this glossary.
• Annual Deductibles and Out-of-Pocket Maximums do not cross-accumulate between in-network and out-of-network coverage. That means out-of-network provider costs apply only to the out-of-network deductible and out of network maximum, while any in-network costs apply only to the in-network deductible and in-network out-of-pocket maximum.

If you have elected healthcare coverage through UBS, in-network preventive care services are generally covered at 100%, and include, for example:

• Annual routine physicals
• For women: Routine mammograms* and routine annual gynecological exam
• For men: Digital Rectal Exams (DRE) and Prostate Specific Antigen (PSA) screenings*
• For children under 18 years: Well-child physical exams and immunizations.
• Colon cancer screenings*

* Please note, minimum age and other requirements may apply to certain medical services.

Please also note that lab work related to annual routine physicals is typically covered at 100% in network. However, lab work and diagnostic services related to other preventive care exams may not be covered at 100% in network.

Check with your healthcare plan administrator for details about the preventive services covered by your plan. Contact details are below.

NOTE: Keep in mind that choosing out-of-network care will result in considerably more cost to you

• For more information on minimum healthcare screenings and immunizations you should consider for yourself and your family, review these lists of preventive care based on the Affordable Care Act lists of no-cost Preventive Care Services.

To find out more about preventive care offered by your healthcare coverage, call your insurer at the number below.