Glossary of Terms
Your benefit terms, clearly defined.
Your benefit terms, clearly defined.
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.
Active enrollment is a benefits enrollment method that requires team members to manually update their benefit selections each year. During an active enrollment, team members must re-evaluate their previous benefit choices and elect from current options for the upcoming year. If a team member doesn’t make a selection, they won’t receive benefits.
The Patient Protection and Affordable Care Act, commonly called the Affordable Care Act is a United States federal statute signed into law by President Barack Obama in March 2010. The law puts in place comprehensive health insurance reforms.
The maximum amount that a carrier will consider to pay for a service, including any amount that the patient will be responsible for paying.
Total dollar amount a plan pays during a calendar year toward the covered expenses of each person enrolled.
When a provider bills you the difference between the provider's charge and the carrier's allowed amount.
The brand formulary is an approved, recommended list of brand name medications. Drugs on this list are available to you at a lower cost than drugs that do not appear on this preferred list.
A deductible beginning on January 1 and ends on December 31. Calendar-year deductibles reset every January 1.
You or your spouse’s or eligible domestic partner’s child who resides within the U.S. and is under age 26 (regardless of student status, marital status, residence or financial dependence). Children will be covered on the medical, Rx and life plans until the end of the year in which they turn 26 (or day before their 30th birthday for dental and vision). Such children include:
A percentage of the medical costs, based on the allowed amount, you must pay for certain services after you meet your annual deductible.
A type of health insurance plan that combines high-deductible insurance plans with health savings accounts, giving policyholders more control over their healthcare expenses.
A team member changes or “converts” their Group Life coverage to an Individual Life Insurance policy without having to answer any medical questions.
Conversion is for a team member who is leaving their job, reducing hours or has reached the age when coverage may be reduced or eliminated and still wants to maintain the protection that life insurance provides.
A set dollar amount you pay for network doctors’ office visits, emergency room services and prescription drugs.
Total dollar amount, based on the allowed amount, you must pay out of pocket for covered medical expenses each calendar year before the plan pays for most services. The deductible does not apply to network preventative care and any services where you pay a co- payment rather than coinsurance. Some of your dental options also have an annual deductible, generally for basic and major dental care services.
A benefits-eligible dependent is a spouse, domestic partner or a child.
A domestic partnership is a relationship between a team member and one other person of the same or opposite sex. Both persons must:
Equipment and/or supplies ordered by for everyday or extended use. Examples include oxygen equipment, wheelchairs, crutches, and blood testing strips.
An embedded deductible combines both individual and family deductibles. This means that no single member of the family will have to pay more than the individual deductible amount, even if the family deductible has not been met. The individual deductible is “embedded” within the family deductible, allowing a single family member to access medical benefits sooner if they reach their individual deductible before the total family deductible is met.
An illness or injury so serious that one must seek care right away to avoid severe harm.
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.
Requirement under the insurer for the covered person to provide a completed application that details the condition of your health or your dependent's health in order to be considered for coverage.
Healthcare services that your insurance doesn't cover.
Account offering tax savings by allowing you to contribute pre-tax dollars from your salary for eligible medical and wellness expenses. Restrictions apply based on the medical plan elected. Funds do not carry over year-over-year and must be used or forfeited.
These drugs are usually the most cost effective. Generic drugs are chemically identical to their brand name counterparts. Purchasing generic drugs allows you to pay a lower out-of-pocket cost than if you purchase formulary or nonformulary brand name drugs.
The amount of life insurance available to you without having to complete an Evidence of Insurability.
Health services that help one keep or improve skills and functioning for daily living. These include physical and occupational therapy, speech therapy, and treatments for a variety of other disabilities.
A form of insurance combining a range of coverage in a group basis. A group of doctors and other medical professionals offer care through the HMO for a monthly rate with no deductibles. Only visits to professionals within the HMO network are covered by the policy.
A portable savings account that allows you to set aside tax-free money for healthcare expenses. You must be enrolled in a Consumer Directed Health Plan (CDHP) 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.
Services to comfort and support individuals in the last stages of a terminal illness.
Doctors or services that have a negotiated partnership with your plan. Using in-network doctors and facilities saves you money.
The percent you pay for covered healthcare services to providers who contract with your health insurance. In-network co-insurance typically costs less than out-of-network co-insurance.
A set amount that you pay for covered services to providers who contract with your health insurance. In-network co-payments typically cost less than out-of-network co-payments.
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.
Medications that you get only after you sign up for the mail-order program. 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 to see if this is a good solution for you.
Prescriptions commonly used to treat conditions that are considered chronic or long term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.
Healthcare services or supplies needed to prevent, evaluate, diagnose or treat an illness, injury, condition, disease or its symptoms, that are all of the following:
A group of healthcare providers, including dentists, physicians, hospitals and other healthcare providers, that agrees to accept predetermined rates when serving members.
Also known as an "aggregate deductible," a non-embedded deductible is a feature of a family health insurance policy. Unlike an embedded deductible, with a non-embedded deductible, there is only a family deductible. All family members’ out-of-pocket expenses count towards the family deductible until it is met. This means insurance will only start paying for services once the entire family deductible has been met, even if only one member has claims. This type of deductible can be simpler than an embedded deductible but may lead to higher out-of-pocket expenses for individual family members if they have significant medical costs.
These drugs are not on the recommended formulary list. These drugs are usually more expensive than drugs found on the formulary. You may purchase brand name medications that do not appear on the recommended list, but at a significantly higher out-of-pocket cost.
A provider without a contract with your insurance plan. You'll generally pay more to see a non-preferred provider.
Doctors or services that do NOT have a negotiated partnership with your plan and might cost you more money.
The percent you pay for covered healthcare services to providers who do not contract with your health insurance. In-network co-insurance typically costs more than out-of-network co-insurance.
The most you'll pay before your insurance begins to pay 100% of the allowed amount. The limit never includes your premium or services that your plan doesn't cover.
The maximum amount of coinsurance a Plan member must pay toward covered medical expenses in a calendar year for both network and non-network services. Once you meet this out-of- pocket maximum, the Plan pays the entire coinsurance amount for covered services for the remainder of the calendar year. Deductibles and copays apply to the annual out-of-pocket maximum.
Passive enrollment is a benefits enrollment method that rolls over team member benefits elections from the previous enrollment period. During a passive enrollment, team members who take no action during annual enrollment receive the benefits they had the previous year (if available).
Preferred Dentist Program Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full, subject to any copayments, deductibles, cost sharing and benefit maximums.
Services provided by a licensed medical physical (M.D. or D.O.)
A benefit your employer or union provides to pay for your healthcare.
A team member carries or “ports” their current Group Life coverage after employment ends, without having to answer any medical questions. Portability is for a team member who is leaving their job and still wants to maintain the protection that life insurance provides.
Plans that allow members to use any healthcare professional without a referral. Staying in-network means smaller copays and more coverage. If you go out-of-network, you'll have higher out-of-pocket costs, and not all services may be covered.
The amount that must be paid for your health insurance by you and your employer.
A plan for active team members that is paid for with pre-tax money. The IRS allows for certain expenses to be paid for with tax-free dollars. The state takes premiums out of your check before taxes are calculated, increasing your spendable income and reducing the amount you owe in income taxes. Consequently, the IRS has tax laws that require you to stay in the plans you select for a full plan year (January through December). You can only make changes during Annual Enrollment or if you have a Qualifying Event.
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.
Getting approval from your provider for the recommended medicine, services or supplies prior to receiving them. Without this prior approval, your health plan may not provide coverage, or pay for the medication, services or supplies. Not all covered health services require prior authorization.
A physician (M.D or D.O.) who provides or coordinates a variety of healthcare services.
A physician (M.D. or D.O.), healthcare professional or facility that is licensed and certified as required by state law.
An occurrence that qualifies the subscriber to make an insurance coverage change outside of Annual Enrollment.
R&C fee refers to the Reasonable and Customary (R&C) charge, which is based on the lowest of: (1) the dentist’s actual charge, (2) the dentist’s usual charge for the same or similar services, or (3) the charge of most dentists in the same geographic area for the same or similar services, as determined by MetLife.
Surgery and treatment needed to correct a part of the body due to birth defects, accidents, or medical conditions.
Services that help a person keep or reclaim skills and functioning for daily living lost due to an illness or injury. Examples include occupational therapy, speech therapy, and select psychiatric services.
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.
An income replacement benefit that provides a percentage of pre-disability earnings on a weekly basis when employees are unable to work due to an illness or injury that’s unrelated to their job. It typically covers off-the-job accidents and illnesses that workers’ compensation would not cover.
Services for licensed nurses in a nursing home or your own home.
A physician that focuses on a specific area medicine or group of patients to diagnose, prevent, or treat certain conditions.
Prescription medications that require special handling, administration or monitoring. These drugs may be used to treat complex, chronic and often costly conditions.
The person to whom you are legally married.
A straightforward summary that allows you to compare costs and coverage between different health plans.
The amount paid for a service in a geographic area based on what local providers typically charge.
Care for a condition or injury serious enough that one would seek care right away, but not one severe enough to require emergency room care.
Additional life insurance on top of the group life Insurance. You can 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.
A program offered by an employer or insurance carrier to incentivize employee health and fitness through discounted gym memberships, gift certificates for preventive care, and more.
The Benefits Service Center is made available to you through the HRConnect Self-Service Portal, providing support from dedicated professionals committed to helping you understand the benefit options available to you. Whether you have questions about your benefit plans, concerns about coverage, or just need guidance on which medical plan is right for you and your family, connect with the Benefits Service Center.
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This Digital Benefits Guide is intended to highlight available benefits and should not be relied upon to fully determine coverage. They are not complete descriptions of the benefits. The company may terminate or modify any benefits described on this website, at any time, for any reason. The descriptions listed on this website are not guarantees of coverage. If there is any conflict between this website and the official plan documents, the official plan documents and contracts will prevail.
Summary of Benefits Coverage are available within this Digital Benefits Guide as well as on MainStreet under Total REWARDS and Workday under My Benefits.
