Helpful Terms

The definitions in the Summary Plan Descriptions provided by the plan sponsor would supersede any of the generic terms in this list.

Insurance that pays fractional amounts of the policy to a covered employee who loses a bodily appendage or sight because of an accident or pays benefits to the beneficiary if the cause of death is due to an accident.

A person designated to receive the income or other benefits from a will, insurance policy, annuity contract, trust, etc.
Coinsurance is your share of the costs of a covered healthcare service, calculated as a percent (for example, 20%) of the allowed amount for the service. Your coinsurance will begin after you have met your deductible. For example, if the health plans allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health plan pays the rest of the allowed amount.
A copay is a fixed dollar amount you pay for a healthcare service. The amount can vary by the type of service. Your copays will not count toward your deductible but will count toward your out-of-pocket maximum.

Disability insurance replaces a percentage of an employee’s income if they become disabled as a result of a covered accident or sickness, to help them continue to make ends meet while they’re out of work.

An employee assistance program is an employee benefit program that assists employees with personal problems and/or work-related problems that may impact their job performance, health, mental and emotional well-being.

An EOB is a statement from the insurance company showing how claims were processed. The EOB tells you what portion of the claim was paid to the healthcare provider and what portion of the payment, if any, you are responsible for.

The application process in which you provide information on the condition of your health or your dependents’ health in order to be approved for coverage.

An HSA is a portable savings account that allows you to set aside money for health care expenses on a tax-free basis. You must be enrolled in an HDHP in order to open an HSA. An HSA rolls over from year to year, pays interest, can be invested, and is owned by you — even if you leave the company.

A network is composed of all contracted providers. Networks request providers to participate in their network, and in return, providers agree to offer discounted services to their patients. If you pick an out-of-network provider, your claims will be higher because you will not receive the discounts the in-network providers offer.
Routine healthcare services can minimize the risk of certain illnesses or chronic conditions. Examples of preventive care services include but are not limited to physical exams, mammograms, flu vaccines, prostate tests and smoking cessation.
Prior authorization is an approval to perform certain services that your doctor or provider needs to obtain from us before they may perform the service. It is your doctor’s responsibility to obtain this approval.
A QLE allows you to make changes to your benefits during the year ONLY if you have a qualified event resulting in a “change in family status.” What is considered a qualifying event? Your marriage, legal separation, or divorce, the birth or adoption of a child, the loss of coverage eligibility for a dependent child, the loss of coverage under your spouse’s or other employer’s plan and the death of a spouse or dependent child.
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