Benefits come with their own vocabulary. Use this quick reference to understand the terms you’ll see when comparing plans and making your elections.
Your share of the cost for care, shown as a percentage. You pay this after meeting your deductible, until you reach your out-of-pocket maximum.
A set amount you may pay for care, like a doctor’s visit or prescription.
The amount you pay each year before your plan starts to help pay for care. Some services, like preventive care, are covered right away.
You may need to answer health questions to qualify for certain coverage, like life or disability coverage, when you enroll late or elect higher coverage amounts.
You can be approved for certain coverage without answering health questions.
Some employer-paid benefits are counted as income for tax purposes.
Care from doctors and hospitals in your plan’s network. This usually costs less than out-of-network services.
Care from doctors and hospitals not in your plan’s network. This usually costs more and you may be balance billed, which is when a provider bills you for the difference between what they charge and what your plan pays.
The most you will pay in a year for covered care. After you reach this amount, your plan pays 100%.
The cost of your plan. You pay part of it through your paycheck, and your employer pays the rest.
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Benefits Lingo
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Benefit Acronyms
AD&D: Accidental Death & Dismemberment
EAP: Employee Assistance Program
EOI: Evidence of Insurability
FSA: Flexible Spending Account
HMO: Health Maintenance Organization
HSA: Health Savings Account
LTD: Long-Term Disability
OOPM: Out-of-Pocket Maximum
PPO: Preferred Provider Organization
QLE: Qualifying Life Event
STD: Short-Term Disability