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COBRA – Consolidated Omnibus Budget Reconciliation Act of 1985. Law that requires employers to offer continued health coverage to terminated employees and their eligible dependents.
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Dependent Care Reimbursement Account – Authorized by the Internal Revenue Service, a Dependent Care Reimbursement Account allows you to pay for qualifying dependent care expenses with pre-tax dollars. Account contributions are directly deducted from your paycheck before taxes are withheld. These pre-tax dollars can be used to obtain reimbursement for expenses like full-time daycare or after-school care.
E
EAP – Employee Assistance Program. Provides counseling and other services to employees.
F
Flexible Spending Account – Authorized by the Internal Revenue Service, Flexible Spending Accounts (FSA) allow employers to offer employees the choice between cash compensation and certain nontaxable (qualified) benefits.
FSA Premium Conversion -This benefit option allows an eligible employee to pay his or her portion of the premium cost of coverage for the employer’s group health or other welfare benefit plan(s) on a pre-tax basis through salary reduction contributions.
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Healthcare FSA – Authorized by the Internal Revenue Service, a Healthcare Flexible Spending Account (FSA) allows you to pay for qualifying healthcare expenses with pre-tax dollars. Account contributions are directly deducted from your paycheck before taxes are withheld. Reimbursements are made for eligible medical expenses not covered by insurance.
Health Insurance Portability and Accountability Act (HIPAA) of 1996 – This federal law mandates significant changes in the legal and regulatory environment for managing patient medical records and communicating information electronically. Known previously as the Kennedy-Kassenbaum bill, HIPAA was enacted primarily to provide improved portability of health benefits and greater accountability in the area of healthcare fraud. HIPAA's Administrative Simplification regulations are designed to reduce administrative costs by standardizing the format of electronic data interchange of certain types of administrative and financial transactions used in healthcare. HIPAA also sets forth far-reaching provisions for protecting the security, confidentiality, and privacy of healthcare information.
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Health Maintenance Organization (HMO) – A type of health plan that provides health care services for members who prepay a premium that generally covers a comprehensive range of both inpatient and ambulatory care with limited copayments. A primary care physician provides or arranges all of their patients' access to care. HMO programs are easy to use and have low out-of-pocket costs. By focusing on preventive care and providing care within a closed network of providers, HMOs are generally less expensive than other medical plans. There are four types of HMOs:
Staff Model (Closed-Panel) – Hires its physicians individually and pays them a salary to practice in the HMO facility or clinic.
Group Model – Contracts with a group of physicians and pays them a set amount per patient to provide a specified range of services. The group of physicians determines the compensation of each individual physician in the practice and often shares profits.
Independent Practice Association (IPA) – Contracts with individual physicians who see HMO members as well as patients covered by other types of health insurance in their own private offices. Physicians in an IPA are paid on either a capitation or a modified fee-for-service basis.
Network – Contracts with a network of medical groups rather than individual physicians. Medical groups may see HMO patients as well as fee-for-service patients.
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Long-term Disability (LTD) – Disability preventing an individual from continuing in an occupation for which he/she was trained or educated, generally for two years or more.
LTD Plan – A plan that provides a partial income-replacement benefit to an employee unable to work because of a disability.
M
Maintenance Medication – A prescription medication that a subscriber takes on an on-going basis.
Medicaid – A federal and state health insurance program designed to provide access to health services for persons below a certain income level. Provides health care to women and children who qualify for Aid to Families with Dependent Children (AFDC) and to elderly persons with low incomes or resources.
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Medically Necessary – Determination by a health care provider that the physical or mental condition of a patient warrants a certain type of medical care.
Medicare – A federal health insurance program designed to provide health care for the elderly and the disabled. People who qualify for Social Security benefits are automatically eligible for Medicare.
Medicare Part D – A voluntary, prescription drug coverage program for the Medicare-eligible population that the federal government began offering in January of 2006.
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Open Enrollment – The time period during which benefit plan enrollees have the opportunity to change their benefit elections.
Out-of-Area Care – Medical care received outside an approved network of facilities in a particular area. Can occur when a patient is traveling, has temporarily relocated, or has an emergency situation.
P
Point of Service Plan (POS) – Combines the low out-of-pocket cost associated with an HMO-type plan with the freedom of choice of an indemnity plan. With a POS plan, a subscriber selects a Primary Care Physician from the plan’s network of participating physicians. When accessing care through the PCP, or if the PCP arranges specialty care, the subscriber pays little in out-of-pocket costs. However, the subscriber has the ability to directly access care outside of the POS network with an additional out of pocket expense.
PHI -- Protected Health Information.
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Preferred Provider Organization (PPO) – A managed care plan with the flexibility of physician choice. PPOs have two levels of care. In-network benefits apply when a subscriber receives services from a participating provider. Out-of-pocket costs are relatively low for in-network services. A subscriber also has the ability to access care outside the PPO network at an additional out of pocket expense.
Primary Care Provider (PCP) – A general or family practice physician, internist, pediatrician, Advanced Registered Nurse Practitioner (ARNP) or physician's assistant (PA) who contracts with a managed care health plan. A subscriber elects a PCP from the network; the PCP is then responsible for managing the patient’s access to the health care system. Q
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Short-Term Disability (STD) – Period of disability precluding normal occupational duties, generally defined as lasting less than two years.
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USERRA – Uniformed Services Employment and Reemployment Rights Act of 1994.
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