38 BENEFITS: A benefit is a form of indirect compensation designed to provide employees added protection, promote goodwill and reward employment. It usually takes a form other than money and are typically extended to employees as well as their immediate family members. BRAND-NAME DRUG: A prescription drug that has been patented and is only available through one manufacturer. CERTIFICATE OF CREDITABLE COVERAGE: A written certificate issued by a group health plan or health insurance company that states the period of time you were covered by your health plan. CLAIM: A request to the insurance company to pay for benefits or services rendered (either by an individual or his or her health care provider). CO-INSURANCE: The percentage or amount that the individual is required to pay after a deductible has been met and before the insurance company will pay. CO-PAYMENT: Amount of money, usually a set amount that a policyholder is required to pay for each visit to a hospital or doctor’s office for services. CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA): Gives workers and their families who lose their health benefits the right to choose to continue group health benefits pro- vided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan. COORDINATION OF BENEFITS: If the insured has more than one health insurance provider, such as being under a spouse’s insurance plan along with their own, the insurance company would not pay double benefits. In this case, the health insurance company would coordinate benefits with the other health insurance plan. DEDUCTIBLE: Refers to the amount of money that the insured would need to pay (per benefit period) before any claims from the health insurance company would be paid. DEFERRED COMPENSATION: Payment for services under any employer-sponsored plan or arrangement that allows an employee (for tax related purposes) to defer income to the future. DEPENDENT CARE FSA: A benefit plan designed to allow employees to set aside pre-tax dollars to pay for eligible dependent care expenses, such as daycare, day camp, or elder care. FSAs are strictly regulated by IRS guidelines and it is the employee’s responsibility to ensure that there their expenses will be eligible for reimbursement prior to enrollment. DISABLED DEPENDENT: If a child who is physically or mentally incapable of self-support is covered under the benefit plan, the child may continue coverage beyond the normal age limit if the disability continues, the child does not have any other insurance coverage and the child remains unmarried. Medical certification of disability must accompany the carriers required documentation. DISPENSE AS WRITTEN (DAW): An order on a prescription commanding the pharmacist to provide the recipient with the prescription exactly as it was written. EXPLANATION OF BENEFITS (EOB): An EOB is not a bill; it is an itemized statement that shows what action was taken on your claims. The EOB explains the services or benefits you received, the doctor(s) visited, the date of service, the amount paid by the insurance company, and any amount you may owe. EMERGENCY CARE: Care for severe pain, injury, sudden illness, or suddenly worsening illness that you believe can cause serious danger to your health if you do not get immediate medical care. EMPLOYEE ASSISTANCE PROGRAM (EAP): An EAP is a free confidential program designed to help employees and their family members deal with personal problems that might adversely impact their work performance, relationships, health, and well-being. Examples of EAP services include confidential expert counseling, legal assistance, stress management, alcohol or drug dependency, and financial services. EMPLOYEE SELF-SERVICE: A trend in human resource management that allows employees to handle many job-related tasks normally conducted by HR (such as benefits enrollment, updating personal information and accessing company information) through the use of a company’s intranet, specialized kiosks or other Web based applications. EVIDENCE OF COVERAGE (EOC): A comprehensive resource guide to your health care coverage. It explains your benefits, premiums, and cost-sharing; conditions and limitations of coverage; and plan rules. EXCLUSIONS: Specific conditions or circumstances for which the insurance policy will not provide benefits. These will be phased out over the next few years with the implementation of health care reform law. EXCLUSIVE PROVIDER ORGANIZATION (EPO) PLAN: A plan under which employees must use providers from the specified network of physicians and hospitals to receive coverage; a more restrictive type of preferred provider organization. There is no coverage for care received from a non-network provider except in an emergency situation under an EPO plan. FAMILY AND MEDICAL LEAVE ACT (FMLA)OF 1993: The Family and Medical Leave Act (FMLA) allows employees who have met minimum service requirements (12 months employed by the company with 1,250 hours of service in the preceding 12 months) to take up to 12 weeks of unpaid leave per year for: (1) a serious health condition; (2) to care for a family member with a serious health condition; (3) the birth of a child; or (4) the placement of a child for adoption or foster care. FAMILY STATUS/LIFE EVENT CHANGE: Used to define changes to an individuals existing family standing. Typically found in health care benefit plans covered by section 125 of the Internal Revenue Code. IRC 125 does not allow individuals enrolled in a covered benefit plan to make election changes to their existing benefits coverage outside of the plans annual open enrollment period, unless a qualifying change in family or employment status, defined by the IRS as a “Qualified Family Status Change” has occurred (i.e. marriage, divorce, legal separation, death, birth/adoption, changes in employment status, cessation of dependent status, or a significant change in cost or reduction of benefits.) You have 30 days to make enrollment changes following a qualifying family status change (life event). Contact the Benefits Office for more information. Glossary of Insurance Terms