Learn the Language of Your Benefits
Helpful Terms & Definitions
Understanding insurance terminology can help you make better decisions about your care and coverage. Below is a glossary of key terms used in your benefit plan descriptions, along with quick video walkthroughs to help you navigate your options.
Media Library
Video Walkthroughs (9)
Watch quick walkthroughs on plan costs, HSA vs. FSA, preventive care, and more in English or Spanish.
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Plan Glossary
Key Definitions (32)
Search and browse clear definitions for health insurance terms, drug tiers, HMO/EPO plans, and accounts.
Browse Definitions
VIDEO LIBRARY
Helpful Benefits Videos
Watch quick video walkthroughs to better understand your benefits, coverage options, and key terminology in English or Spanish.
Benefits Lingo
Get familiar with essential health care and insurance terminology so you can navigate your benefits with ease.
Cost for Coverage
Learn how plan premiums, deductibles, copays, and coinsurance work together to make up your overall health care costs.
EAP (Employee Assistance Program)
Discover free, confidential counseling, financial guidance, legal consultations, and work-life resources available through your EAP.
FSA (Flexible Spending Account)
Understand how FSAs let you use pre-tax dollars to pay for eligible health care and dependent care expenses throughout the plan year.
HSA (Health Savings Account)
See how an HSA pairs with a high-deductible health plan to offer triple tax advantages and long-term health care savings.
HSA vs. FSA
Compare Health Savings Accounts and Flexible Spending Accounts to determine which tax-advantaged account best fits your health needs.
Preventive Care
Find out what counts as 100% covered in-network preventive care and how routine check-ups protect your health and wallet.
Where to Go for Care
Know when to use telemedicine, your primary care doctor, urgent care, or the emergency room to save time and money.
Worksite Benefits
Explore optional voluntary indemnity plans including accident, critical illness, hospital indemnity, and life coverage.
PLAN GLOSSARY
Glossary of Terms & Definitions
Search and filter clear explanations for insurance terminology, plan types, and tax accounts.
After-Tax dollars
When Benefits are paid after tax, deductions are taken after income taxes are paid.
Ancillary Benefits
Optional benefits that provide extra protection and support beyond your medical plan. For example: Home and Auto Insurance, Commuter Benefit Plan, and 401(k).
Arrears Eligible Company-Sponsored Benefits
Includes all health, ancillary and voluntary benefits except for Health Savings Account and 401(k) contribution.
Balance Bill
When an out-of-network provider bills you for the difference between their charge and the amount your medical plan allows.
Brand Formulary
A list of generic and brand name prescription drugs covered by a health plan.
Brand Non-Formulary
Brand name medication that have no available generic equivalent. Typically, they require the highest out of pocket expense. Prior Authorization may be required.
COBRA Coverage
The Consolidated Omnibus Budget Reconciliation Act of 1985 ("COBRA") requires employers to offer continuation of Medical, Dental, and Vision coverage and (in certain circumstances) Health Flexible Spending Account ("HFSA") coverage to qualified employees and family members enrolled in the plans at the time of certain qualifying events for a period of generally up to 18 or 36 months depending on the qualifying event (or until the end of the plan year for the HFSA benefit).
Coinsurance
The percentage paid for a covered service, shared by you and the plan. Coinsurance can vary by plan and provider network. Review the plans carefully to understand your responsibility. You are responsible for coinsurance until you reach your plan's out-of-pocket maximum.
Copay
A fixed dollar amount you pay the provider at the time of service; for example, a $20 copay for an office visit or a $10 copay for a generic prescription.
Deductible
The amount you pay each calendar year before the plan begins paying benefits. Not all covered services are subject to the deductible; for example, the deductible does not apply to preventive care services.
DHMO (Dental Health Maintenance Organization)
A dental plan that helps keep costs low by providing care through a network of participating dentists.
EPO (Exclusive Provider Organization)
A health plan that covers care from doctors and hospitals in its network, helping keep costs lower while giving you flexibility to see specialists without a referral.
Evidence of Insurability
The process of providing health information to qualify for certain insurance coverages. EOI is required when enrolling in Long-Term Disability (LTD) outside of your initial eligibility period or for Supplemental Life coverage beyond the Guaranteed Issue amount.
Flexible Spending Account (FSA)
An arrangement through your employer that lets you pay for many out-of- pocket expenses with tax-free dollars. The FSA funds are only good for the coverage year. Any funds remaining at the end of the year, will be lost, and not available for use. This benefit election can change with a QLE or during OE.
Generic Drugs
Medication created to be the same as an already marketed brand name drug in dosage form, safety, strength, and route of admission.
Health Benefits
The medical, prescription, and preventive care coverage that help you stay healthy and manage healthcare costs. For example: Medical, Dental, Vision, Health Care Flexible Spending Account (FSA), Health Savings Account (HSA), Supplemental Life and AD&D.
Health Reimbursement Arrangement (HRA)
An employer-funded benefit that helps reimburse eligible healthcare expenses, such as medical, prescription, dental, and vision costs.
Health Savings Account (HSA)
A savings account used in conjunction with a high-deductible health insurance plan that allows the employee to use pre-tax dollars for medical expenses. Any unused funds at the end of the coverage year will roll over into the next coverage year. Election changes can be made during anytime of the year.
HMO (Health Maintenance Organization)
A type of health plan that provides coordinated care through a network of doctors and hospitals, helping keep healthcare costs lower.
In-Network Care
Care provided by contracted doctors within the plan’s network of providers. This enables participants to receive care at a reduced rate compared to care received by out-of-network providers.
Open Enrollment
Each fall, the Health Benefit Plan offers all eligible participants an opportunity to enroll in or change current Health Benefits for the subsequent Plan Year.
Out-of-Network Care
Care provided by a doctor or at a facility outside of the plan’s network. Your out-of-pocket costs may increase, and services may be subject to balance billing. Depending on the plan you select, you may not have any out-of-network coverage.
Out-of-Pocket Maximum
The maximum amount you pay per year before the plan begins paying for covered expenses at 100%. This limit helps protect you from catastrophic expenses.
PCP (Primary Care Provider)
Your main doctor who helps coordinate your healthcare and refers you to specialists when needed. They provide routine care, preventive services, and guidance on managing your overall health.
Premium
The complete cost of your plans. You share this cost with your employer for some plans and pay your portion through regular paycheck deductions.
Pre-Tax dollars
When benefits are paid pretax, deductions are taken off your gross income before income taxes are paid.
Preventive Care
Routine health care, including annual physicals and screenings to prevent disease, illness, and health complications. In-network preventive care is covered at 100%.
Qualified Life Event (QLE)
Health Benefits can be changed outside of the Annual Open Enrollment only if you have a qualified event or family status change, which include having/adopting a baby, a marital status change, gain or loss of another group coverage for you or your eligible dependents, employment changes that affects your benefits, disability or death.
Specialty Drugs
Typically, high cost prescription medication used to treat complex and chronic conditions.
Specified Preventive Drugs
Medications that help protect against or manage certain medical conditions.
Vesting/Vested
Vesting of employer contributions typically occurs according to a set timeframe known as a vesting schedule. When employer contributions to a 401 (k) become vested, it means that money is now fully yours. Being fully vested means that when you leave the company, those employer contributions will remain in your account.
Voluntary Benefits
Optional benefits you can choose to enroll in to provide extra financial protection and support for you and your family For example: Short Term Disability (STD), Critical Illness Insurance, and Hospital Indemnity Insurance.
