| Beneficiary |
Person or persons you name to receive benefits in the event of your death. |
| Benefit Plan Year |
October 1 through September 30. |
| COBRA |
Stands for Consolidated Budget Omnibus Reconciliation Act, which is the federal
law that requires employers to allow for continued coverage through a group
health plan for up to 18 months after losing eligibility in the group plan, on a
self-pay basis. |
| Coinsurance |
Percentage of eligible health care expenses you pay after your deductible has
been met. |
| Consumer Driven Health Plan (CDHPs) |
Health insurance plan with lower premiums and higher deductibles, that is
typically combined with a tax-advantaged Health Savings Account (HSA) that can
be used to pay for eligible health care expenses. CDHPs give employees more
control over their health care options. |
| Copay |
Fixed dollar amount you pay for a covered health care service at the time the
service is provided; applies to Kaiser Plan. |
| Covered Service |
Health care services that the plan will cover in part or in full based on plan
documents. |
| Deductible |
Amount you pay each plan year for covered health care services before the plan
begins to pay benefits. |
| Eligibility Date |
Date you are eligible to participate in JACK benefits and enroll online through
MyUltiStuff. |
| Effective Date |
Date your benefit coverage begins. |
| Evidence of Insurability (EOI) |
Application process in which you provide information on the condition of your
health or your dependent’s health to get certain types of insurance coverage.
|
| Health Maintenance Organization (HMO) |
Managed health care program where services are coordinated by a primary care
physician (PCP), including referrals to specialists within the HMO network (i.e.
the Kaiser Plan). |
| Health Savings Account (HSA) |
Type of tax-advantaged savings account where you can contribute tax-free money
to pay for qualified medical expenses. |
| In-Network Provider |
Any licensed doctors, hospital, lab, or other health care provider that has
contracted to provide members with comprehensive services at discounted rates.
|
| Out-of-Network Provider |
Any licensed doctors, hospital, lab, or other health care provider that is not
part of a provider network. Rates are typically higher than in-network
providers. |
| Out-of-Pocket Maximum |
Maximum amount you will have to pay Out-of-Pocket in a plan year for covered
health care services, including prescriptions. Once you reach the Out-of-Pocket
maximum, the plan pays 100% of covered services. |
| Qualified Life Event (QLE) |
A change in your life status such as marriage/divorce, having/adopting a baby,
losing/gaining health coverage, that qualifies you to be eligible for a special
enrollment period where you can enroll in health coverage outside of the Annual
Open Enrollment period. You have 30 days after the event occurs to make benefit
changes. |
| Premium |
Amount you pay for your selected benefit plans each bi-weekly pay period. |
| Preventive Care |
Routine health care, including screenings, check-ups, and patient counseling to
prevent or discover illness, disease, or other health problems. |
| Reasonable & Customary (R&C) |
Maximum amount the plan will pay for a service, based on what providers in that
geographic area charge for similar services or supplies. |
| Formulary |
List of prescription drugs covered by the health insurance plan and which
coverage tier they fall under (i.e. generic, preferred, non-preferred). |
| Generic Drug |
Prescription drug that is equivalent to a brand-name drug with the same active
(main) ingredients and is subject to the same FDA standards for quality,
strength and purity. Generic drugs almost always cost less than brand-name
drugs, although not all brand-name drugs have generic equivalents. |
| Preferred Brand Drug |
Prescription drug that is considered a “preferred choice” based on its
effectiveness and cost. |
| Non-Preferred Brand & Specialty Drug |
Prescription drug that isn’t on the Plan’s preferred list. |
