| A | B |
|---|
| After-Tax (also Post-Tax) | Refers to paying for benefits coverage using money after taxes have been withheld. |
| Before-Tax (also Pre-Tax) | Refers to paying for benefits coverage using money before taxes have been withheld from a paycheck |
| Beneficiary (for Life or Accident Insurance) | The person or trust you elect to receive the proceeds of your life or accident insurance policy when you die. You may name any person or organization as your beneficiary (you may name multiple beneficiaries) and you may change your beneficiary as often as you wish |
| Claim Form | A form filled out and submitted by a participant in order to receive reimbursement for health care or life insurance expenses. |
| Coinsurance | The percentage of covered expenses that a participant pays out-of-pocket (generally after meeting a deductible or paying a copayment). Employees might be required to pay additional amounts in excess of Reasonable and Customary (R&C) charges. |
| Coordination of Benefits (COB) | COB provisions are generally accepted guidelines that determine which health care plan pays first (primary) and which plan pays second (secondary) when more than one health care plan covers an individual. |
| Deductible | Amount a participant pays each plan year for covered expenses before the plan begins to pay benefits. |
| Co-pay | A flat dollar amount a participant is required to pay to a health care provider or for a prescription drug benefit at the time of receiving service. |
| EOI | To provide Evidence of Good Health, a participant might be required to submit documentation before certain insurance coverage (or coverage levels) can be approved. The insurance carrier decides if evidence is satisfactory |
| Flexible Spending Accounts | Accounts set up by employers to help employees pay for health and dependent care expenses that are not normally reimbursed by the plan |
| Imputed Income | If you have Basic Life Insurance coverage in excess of $50,000, the company-paid cost (not the coverage amount) of your elected life insurance coverage in excess of $50,000 is considered "imputed income," on which you must pay taxes. This cost will appear on your year-end W-2 form as taxable income. |
| In-Network | Refers to the source of your care. If you receive care from a licensed health care provider who is a member of a Point of Service (POS) Plan or Preferred Provider Organization (PPO) network, you receive a higher level of coverage for both inpatient and outpatient care. |
| Lifetime Maximum | The most that will be paid by a plan for covered services. Not all plans apply a lifetime maximum, and some plans have different lifetime maximums for different services. Once you reach the lifetime maximum, you pay all expenses over that amount. |
| Long-Term Disability | Provides coverage disability coverage if you are unable to work. |
| Medicare | A federal program that provides medical insurance for individuals age 65 or older. |
| Open Enrollment | A designated period of time during the plan year when a participant is allowed to make new or change existing benefit elections, including changes to coverage levels and dependent coverage. After Open Enrollment, before-tax changes can generally be made only if the participant experiences a Qualified Life Event as defined by the Plan. Depending upon Plan rules, retirees might not be able to make changes during Open Enrollment. |
| Out-of-Network | Refers to the source of your care. For Point of Service (POS) plans, care received from a physician or other health practitioner without a referral and/or who is not part of the managed care network is referred to as “out-of-network” care. For Preferred Provider Organization (PPO) plans, care received from a non-network provider is also referred to as “out-of-network” care. |
| Out-of-pocket Maximum | The maximum amount a participant will pay for covered medical expenses before the plan begins to pay 100% of the Reasonable and Customary (R&C) charges for most remaining covered expenses, for the rest of the plan year. The participant might still be responsible for paying uncovered charges and amounts over R&C charges. |
| Participant | Any employee or former employee who is or might become eligible to receive a benefit from a healthcare plan, or whose beneficiaries might be eligible to receive a benefit. If the employee or former employee dies, the surviving spouse generally becomes the participant. |
| Reasonable and Customary (R&C) Charges | The usual amount a doctor or other health care provider charges in a participant’s geographic location for the same or a similar treatment, service or supply, as determined by the insurance carrier. A participant pays expenses that are in excess of the R&C charge. |
