| A | B |
|---|
| Refers to paying for benefits coverage using money after taxes have been withheld. | After-Tax |
| Refers to paying for benefits coverage using money before taxes have been withheld from a paycheck. | Before-Tax |
| insurance Company that provides coverage and processes claims for a specific benefit | Carrier |
| The percentage of covered expenses that a participant pays out-of-pocket (generally after meeting a deductible or paying a copayment). | Coinsurance |
| 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 | Co-pay |
| Indicates who is covered for a particular benefit. A participant chooses a coverage level for themselves, or one that also includes their spouse, children or entire family | Coverage Level (also Coverage Tier): |
| Refers to plan rules defining who can be covered by a particular benefit. | Eligibility |
| 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. | Evidence of Good Health (EOI) |
| Accounts set up by employers to help employees pay for health and dependent care expenses that are not normally reimbursed by the plan. | Flexible Spending Accounts (FSAs |
| 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. | Imputed Income |
| Employers generally allow an occasional paid or unpaid break from service for a variety of reasons | Leave of Absence (LOA) |
| A federal program that provides medical insurance for individuals age 65 or older. | Medicare |
| 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. | Out-of-pocket Maximum |
| Period of time defined by the Plan in which a particular set of benefits is offered. | Plan Year |
| The periodic payment made on an insurance policy. | Premium |
| 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 | Reasonable and Customary (R&C) Charges |
| Indicates that you must contact your health plan administrator prior to receiving certain treatments or services in order to have your treatment authorized or approved | Pre-Authorization |
| 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. | Participant |
| 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. | Open Enrollment |
| the employer has determined their prescription drug coverage to be as good as the Medicare prescription drug coverage | Creditable Coverage |
