Benefits Glossary

Your share of costs after meeting your deductible. For example, you pay 20% and insurance pays 80%.

A fixed amount you pay for a covered service, like $25 for a doctor visit.

The amount you pay out-of-pocket before your insurance starts paying for covered services.

A statement from your insurance showing what was covered and what you owe for a claim.

Doctors and facilities that have agreements with your insurance to provide services at lower rates.

Providers without agreements with your insurance. Using them typically costs more.

The most you'll pay in a year. After reaching this, insurance covers 100% of covered services.

The amount you pay each month for your insurance coverage.

A list of prescription drugs covered by your insurance plan, organized by cost tiers.

A health plan with a higher deductible and lower premiums. Required to open an HSA. Generally covers preventive care at 100% before the deductible.

A plan that requires you to use in-network providers and get referrals to see specialists.

A plan that offers flexibility to see any provider, with lower costs for in-network care.

Routine healthcare to prevent illness, like annual checkups and vaccinations. Often covered at 100%.

Your main doctor who provides routine care and coordinates specialist referrals.

A written order from your primary care doctor for you to see a specialist. Required in HMO plans.

A doctor who focuses on a specific area of medicine, like cardiology or orthopedics.

Dental treatment to correct misaligned teeth and jaws (braces, retainers). Often has separate coverage limits and waiting periods.

The dollar amount your vision plan covers toward the cost of contact lenses (typically instead of glasses).

The dollar amount your vision plan covers toward the cost of eyeglass frames.

The person(s) designated to receive benefits from your life insurance or retirement accounts upon your death.

Medical information required for certain coverage amounts, reviewed by the insurance company before approval.

Coverage amount available without medical underwriting or health questions.

Life insurance that provides coverage for a specific period (term). No cash value, but typically more affordable than permanent life.

Permanent life insurance with a cash value component that builds over time. Higher premiums than term life.

The maximum length of time disability benefits will be paid (e.g., 2 years, to age 65).

The waiting period after disability begins before benefits start paying. Common periods are 30, 60, or 90 days.

Own Occupation pays if you cannot do your specific job. Any Occupation pays only if you cannot do any job you are qualified for.

The yearly period when you can enroll in or change your health coverage.

Federal law allowing you to continue employer health coverage for a limited time after leaving a job. You pay the full premium plus administrative fee.

The annual timeframe when you can enroll in, change, or cancel your health insurance coverage.

Major life changes (marriage, birth, job loss) that allow you to enroll or change coverage outside of annual enrollment.

The time you must wait after starting employment before your health insurance coverage begins.

A pre-tax account for healthcare or dependent care expenses. Must be used within the plan year or grace period (use-it-or-lose-it rule applies).

Additional time after the plan year ends to use remaining FSA funds or submit claims. Typically 2.5 months.

A tax-advantaged savings account for medical expenses, paired with a high-deductible health plan. Contributions are tax-deductible and funds roll over year to year.

Supplemental coverage that pays benefits for injuries from covered accidents, helping with out-of-pocket costs.

Supplemental insurance that pays a lump sum if you are diagnosed with a serious illness like cancer, heart attack, or stroke.

Supplemental insurance that pays a fixed amount per day for hospital stays, regardless of actual costs.

A family member (spouse, child, or domestic partner) who can be covered under your health insurance plan.

The group of doctors, hospitals, and healthcare providers contracted with your insurance plan.

A health condition that existed before your coverage start date. Under the ACA, insurers cannot deny coverage or charge more for pre-existing conditions.

Approval from your insurance required before receiving certain medications, procedures, or services to ensure they are covered.

A standardized document that explains what a health plan covers and what it costs, making it easier to compare plans.