Insurance Glossary of Terms

ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D)

An additional life insurance benefit. This covers death due to a sudden, unexpected accident. You may also get a percentage of the benefit amount if you lose the ability to use a part of your body in an accident.

ANNUAL MAXIMUM

This is the maximum dollar amount that the insurance carrier will pay toward dental services per person per year. If you go over the annual maximum amount, you are responsible for 100% of additional charges until the plan resets the following year.

BRAND NAME DRUG

The original manufacturer’s version of a drug. Because the research and development costs that went into developing these drugs are reflected in the price, brand name drugs cost more than generic drugs.

COINSURANCE

The “cost-share” between you and the insurance carrier (e.g., Anthem). It is a percentage of the costs you pay “out-of-pocket” for covered expenses after you meet your deductible. For example, you pay 20% while the insurance carrier pays 80%.

COPAY (COPAYMENT)

A set fee you pay “out-of-pocket” for certain services, such as a doctor’s visit or medication.

DEDUCTIBLE

The amount you pay “out-of-pocket” before the health plan will start to pay its share of covered expenses.

DENTAL MAXIMUM ROLLOVER

If you did not reach your annual maximum in the prior year, your insurance carrier will roll over up to a certain amount into the new year. This rollover increases your annual maximum for the next year.

DEPENDENT

An eligible dependent is a spouse or a child that meets the following criteria:

Spouse: Legally married

Child: The employee’s or spouse’s natural or adopted child for which the employee or spouse has legal custody/guardianship and who meets the age requirements of the plan.

EVENT DATE

The day in which you become injured, sick, or give birth. The event date marks the beginning of your disability claim regardless of whether it is for short-term or long-term disability.

EVIDENCE OF INSURABILITY (EOI)

A medical questionnaire for you or any dependent you are trying to add or increase coverage for. The insurance provider requires this form because it wants to evaluate the risk of insuring you. The insurance provider is looking for medical history or a current condition that would increase your likelihood of using the benefit. The insurance provide will review your completed form and has the authority to approve or deny your request to enroll in the benefit amount you elected.

You will be required to complete this form if:

You are a new hire and elect a benefit amount over the Guarantee Issue.

You are not a new hire and not currently enrolled, and you are electing life or disability coverage for the first time for yourself or an eligible dependent.

You are not a new hire and currently enrolled, and you are wanting to increase the benefit amount for yourself or an eligible dependent.

GENERIC DRUG

A lower-cost alternative to a brand name drug that has the same active ingredients and works in a similar way.

GUARANTEE ISSUE

A life insurance policy that is “guaranteed to be issued.” This means you are guaranteed a certain benefit amount, regardless of your health status. In other words, you cannot be turned down for this amount.

HEALTH SAVINGS ACCOUNT (HSA)

A portable savings account that allows you to set aside tax-free money for healthcare expenses. You must be enrolled in a High Deductible Health Plan (HDHP) to open an HSA. An HSA rolls over from year to year, pays interest, can be invested, and is owned by you even if you leave the company.

HIGH DEDUCTIBLE HEALTH PLAN (HDHP)

A health plan that has lower premiums and higher deductibles than traditional health plans. Only those enrolled in an HDHP are eligible to open and add tax-free money to a health savings account (HSA).

IN-NETWORK

Doctors or services that have a negotiated partnership with your plan. Using in-network doctors and facilities saves you money.

LONG-TERM DISABILITY

Insurance that protects your income if you are unable to work due to a long illness or injury. This insurance goes into effect after you have been out of work for a specific period of time.

MAIL-ORDER MEDICATION

Medications that you get only after you sign up for the mail-order program with Anthem. Once you sign up, your medications can be mailed directly to your home address and, generally, in a higher quantity (e.g., 90-day supply). Signing up for mail-order medications can save you money, but it is not a guarantee. Consult with your doctor and Anthem to see if this is a good solution for you.

OUT-OF-NETWORK

Doctors or services that do NOT have a negotiated partnership with your plan and might cost you more money.

OUT-OF-POCKET MAXIMUM

The most you pay each year “out-of-pocket” for covered expenses. Once you have reached the out-of-pocket maximum, the health plan pays 100% for covered expenses.

PREVENTIVE CARE

Healthcare services that you get when you are not sick or injured. These are designed to keep you healthy. They include annual checkups, gender- and age-appropriate health screenings, well-baby care, and immunizations recommended by the American Medical Association.

QUALIFYING LIFE EVENT (QLE)

A QLE allows you to make changes to your benefits during the year ONLY if the event results in a “change in family status.” To make benefit changes, you must notify your HR department within 30 days of the event date.

Some examples include:

Birth of a child

Marriage/divorce

Death of a dependent

Loss of other coverage

RETAIL MEDICATION

Medications that you get from a physical pharmacy, such as Walgreens, CVS, or Target. Generally, retail medications are offered only as a 30-day supply.

VOLUNTARY LIFE INSURANCE

This is life insurance available to you and your family. You can voluntarily enroll in this coverage for yourself, your spouse or child(ren). Your dependents are eligible to enroll only if you are also enrolled yourself. You are responsible for the full premium.