Please click on a term below to learn more
ACA (Patient Protection and Affordable Care Act)
Also called Health Care Reform, the intent of the ACA is to make affordable health care available to all Americans. The ACA became law in March 2010. Since then, the ACA has required some changes to medical coverage - like covering dependent children to age 26, no lifetime limits on medical benefits, free preventive care, etc.
Brand Named Drug (or Preferred Brand)
The original manufacturer’s version of a drug. Because research and development costs that went into developing these drugs are reflected in the price, brand name drugs cost more than generic drugs.
Coinsurance
A percentage of costs you pay “out-of-pocket” for covered expenses after you meet your deductible.
Copay (Copayment)
A fee you must pay “out-of-pocket” for certain services, such as a doctor’s office visit or prescription drug.
Deductible
The amount you pay “out-of-pocket” before the health plan will start to pay its share of covered expenses.
Elimination Period
An elimination period is the timeframe an insured person must wait before their insurance benefits become payable.
Employee Assistance Program (EAP)
A program that offers free and confidential counseling, and resources to employees and their dependents who have personal and/or work-related concerns.
Employer Contribution
Either monthly or annually, the company provides you with an amount of money that you can apply toward the cost of your health care premiums. The amount of the employer contribution depends on whom you cover. You can see the amount you’ll receive when you enroll. If you’re enrolling as a new hire, the employer contribution amount will be prorated based on your date of hire.
Evidence of Insurability (EOI)
An application process in which you provide information on the condition of your health or your dependents' health to be considered for certain types of insurance coverage.
Flexible Spending Account (FSA)
A Flexible Spending Account (FSA) is a spending account set up through your employer that allows you to pay for many out-of-pocket medical expenses with tax-free dollars. Approved expenses include insurance copayments and deductibles, qualified prescriptions, insulin, medical devices and more. The annual limit is set by the IRS each year and you decide how much to contribute to your account. If money is left at the end of the year it is forfeited, unless the employer allows you to carry over an IRS approved amount to spend the next plan year.
Generic Drug
A lower-cost alternative to a brand-name drug that has the same active ingredients and works the same way.
Guaranteed Issue (GI)
The amount of insurance under which you cannot be declined insurance coverage due to health status.
Health Maintenance Organization (HMO)
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
High Deductible Health Plan (HDHP)
High-Deductible Health Plans (HDHPs) are health insurance plans with lower premiums and higher deductibles than traditional health plans. Only those enrolled in an HDHP are eligible to open and contribute tax-free to a Health Savings Account (HSA).
Health Savings Account (HSA)
A Health Savings Account (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 a High-Deductible Health Plan (HDHP) 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.
Network
The plan’s preferred doctors, pharmacists, and/or other health care providers. When you use in-network providers, you pay less because they have agreed to pre-negotiated pricing. Also called in-network.
Out-Of-Pocket Maximum
The most you pay each year directly, from your own personal funds for covered expenses. Once you’ve reached the out-of-pocket maximum, the health plan pays 100% for covered expenses.
Preferred Provider Organization (PPO)
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers that usually offer low, fixed copays and coinsurance for most services. The monthly premiums are higher, but the overall cost for services are lower. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Premium
An amount you pay for your insurance to keep the policy active.
Preventive Care
Health care services you receive when you are not sick or injured - so that you stay healthy. This includes annual check-ups, gender, and age-appropriate health screenings, well-baby care, and immunizations recommended by the American Medical Association.
Plan Year
The year for which the benefits you chose during Open Enrollment remain in effect.
Telehealth/Virtual Visit
The delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via computer, tablet, or mobile application device.