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| Term | Definition |
| Cafteria Plan | Allows employees to pay certain qualified expenses (such as health insurance premiums) on a pre-tax basis, thereby reducing their total taxable income and increasing their spendable/take-home income. |
| COBRA | Consolidated Omnibus Budget Reconciliation Act; landmark federal law passed by Congress in 1986.
Provides continuing coverage of group health benefits to employees and their families upon the occurrence of certain qualifying events where such coverage would otherwise be terminated. Qualifying events include voluntary or involuntary job loss, reduction in hours worked, job transition, death, divorce and other life events. Coverage may be extended for a maximum of 18 months due to employment termination or reduction of hours worked. |
| Co-payment | A form of medical cost sharing in a health insurance plan that requires an insured person to pay a fixed dollar amount when a medical service is received. The insurer is responsible for the rest of the reimbursement. |
| Deductable | A fixed dollar amount during the benefit period that an insured person pays before the insurer starts to make payments for covered medical services. Plans may different amounts for individuals and families |
| Dental Insurance | Insures against the expense of treatment and care of dental disease and accident to teeth. |
| Disability | A medical condition, whether physical or mental, resulting from accident or sickness preventing a person from being able to work. |
| Disability Income | Replaces lost wages (net earnings) if you should become disabled. This type of policy will cover your loss of income only if you are totally disabled as defined in the policy |
| Disability Income Insurance | Payment provoked because physical or mental incapacity prevents the insured from being able to work. |
| Disability Insurnace | Provides payments to replace lost wages if an individual cannot work |
| Flexible Spending Account (FSA) | Employees may set aside on a pre-tax basis a pre-established amount of money per plan year. The funds must be used to pay for eligible medical, dependent care, or transportation expenses.
The 'use it or lose it' rule applies; any funds remaining in the participating employee's account at the end of the plan year will be forfeited to the employer |
| Health insurance | A type of insurance coverage that pays for medical and surgical expenses that are incurred by the insured. Health insurance can either reimburse the insured for expenses incurred from illness or injury or pay the care provider directly. |
| Health Maintenance Organization (HMO) | A plan that offers a wide range of health care services through a network of providers that contract exclusively with the health organization, or who agree to provide services to members at a pre-negotiated rate. Members of the organization must select a primary care physician (PCP) who will provide most of their health care |
| Health Savings Account (H.S.A) | An account created for individuals who are covered under high-deductible health plans to save for medical expenses that their plan does not cover. Contributions are made into the account by the individual or the individual's employer and are limited to a maximum amount each year. The contributions can be used to pay for qualified medical expenses. |
| HIPAA | A federal law protecting the privacy of patient-specific health care information and providing the patient with control over how this information is used and distributed. |
| In-Network | Providers or health care facilities that are part of a health plan's network of providers with which it has negotiated a discount. Insured individuals usually pay less to these providers, because they provide services at lower cost to the insurance companies with which they have contracts. |
| Long Term Care Insurance | Insurance that is sold by private insurance companies to cover the cost of convalescent nursing home care, or home health care. |
| Maximum Out of Pocket | The most the insured will have to pay during a policy period (usually a year) for health care services. Once reached, the plan begins to pay 100 percent of the allowed amount for covered services. |
| Maximum Plan Dollar Limit | The maximum amount payable by the insurer for covered expenses for the insured and each covered dependent while covered under the health plan. |
| Medicaid | Low or no-cost health insurance through the government for people with little or no assets or income. Participants do not have to be 65 to get Medicaid |
| Out-of-Network | Doctors, hospitals, and other health care providers that are outside the network that an insurance company contracts with. The insured will likely pay more for visiting this type of provider |
| Patient Protection and Affordable Care Act (PPACA) | Health care reform law in America that is intended to expand access to insurance, increase consumer protections, emphasize prevention and wellness, improve quality and system performance, expand the health workforce, and curb rising health
care costs.spending; also known as "Obamacare" or the "Health Exchange" |
| Patient Protection and Affordable Care Act (Provisions) | - Require employers to cover their workers, or pay penalties, ( some exceptions)
- Require individuals to have insurance *some exceptions)
- Young adults up to age 26 can now stay on their parent’s health insurance.
- Provides access to coverage for adults who have denied due to pre-existing condition
- Plans must provide, free of cost, preventive screenings and services
- Health insurance plans include unlimited lifetime benefits. |
| Preferred Provider Organization (PPO) | Insured persons need to get medical care from doctors or hospitals on the insurance company's list of preferred providers if they want their claims paid at the highest level. Services rendered by out of network providers may not be covered or may be paid at a lower level. |
| Primary Care Physician (PCP) | Individual that coordinates your care and makes referrals to specialists as needed; required by some policies |
| Referral | A written order from your primary care doctor for you to see a specialist or get certain medical services. Some health insurance plans require the insured to get this before they can get medical care from anyone except their primary care doctor. |
| Social Security | Federal social insurance program which provides retirement, disability, and survivors benefits. Also referred to as OASDI, or Old Age, Survivors, and Disability Insurance. |
| Specialist | A doctor who has been specially trained in and practices a specific type of medicine other than primary care (e.g., cardiologists, dermatologists, gastroenterologists) |
| Vision Care | Usually not offered as an employer paid benefit, but when it is it often covers an annual eye exam and eyeglasses once every two years |
