Glossary of Health Insurance Terms

We hope you’ll find this list of healthcare-related terms and information beneficial. Please note that though we believe these terms and definitions are up to date and accurate, this free resource is provided “as is” and should be considered general information only. (Note: We thank A.D.A.M. for providing these glossary terms and definitions.)

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Term Definition
401(k) plan (also called a cash or deferred arrangement or CODA) a plan under Section 401(k) of the Internal Revenue Code that allows employees to choose between receiving compensation, and electing to have that compensation contributed on their behalf to a qualified plan.
403(b) plan (also called a Tax Sheltered Annuity plan or TSA) a plan under Section 403(b) of the Internal Revenue Code that allows employees of certain charitable and educational institutions to choose between receiving compensation, and electing to have that compensation contributed on their behalf to a qualified plan.
404(c) plan an individual account plan in which the participants or beneficiaries direct the investment of their accounts from a range of options, and no plan fiduciary will be held responsible for losses from that direction.
457 plan a tax-deferred plan available to states and certain other political entities under Code Section 457.
60-day roll-in contribution a distribution an employee received from a former employer’s qualified plan, or withdrew from a conduit IRA, and deposited in a qualified retirement plan with the current company that accepts rollovers. Mandatory tax withholding and a 60-day deadline apply.
Abutment the tooth or root that supports a bridge or other structure to replace certain natural teeth.
Accelerated contributions (catch-up contributions) for tax-sheltered annuity plans, extra contributions a participant may make in certain years to help make up for less than maximum contributions in previous years.
Accident insurance coverage for bodily injury due to an accident.
Accidental death and dismemberment (AD&D) insurance coverage for death or loss of a body part or function due to an accident.
Account balance plan (cash balance plan) a type of defined benefit retirement plan that expresses an employee’s benefit as an account balance growing at a pre-announced rate of interest. The company adds credits to the balance each year.
Accrued benefits for a defined benefit retirement plan, benefits that a participant accumulates based on years of service, expressed as a dollar amount of benefit to begin at the plan’s normal retirement age. For any other type of retirement plan, the accrued benefit is the balance in the participant’s account.
Actively at work the employee is present on the job, or otherwise meets the plan’s requirements for being actively at work (such as, on a holiday, was actively at work on the last regularly-scheduled day).
Activities of daily living (ADLs) activities such as dressing, feeding, and toileting, that a participant needs to perform for self-care. ADLs may help determine a participant’s eligibility for benefits under a long-term care plan.
Acupuncture the practice of piercing the body with fine needles to relieve pain, induce anesthesia, and treat illness and injury.
Acupuncturist a qualified provider who practices acupuncture.
Acute care treatment for a severe and short-term health problem.
AD&D see accidental death and dismemberment.
ADLs see activities of daily living.
Adoption assistance program a program to reimburse employees for their eligible expenses to legally adopt a child. The program may cover expenses such as adoption agency and legal fees, pregnancy and hospital expenses of the birth mother, and immigration and naturalization expenses.
Adoption leave leave of absence granted by a company due to adoption or placement of a child for purposes of adoption.
Adult care assistance see adult care services.
Adult care services services to allow a disabled or elderly adult to function at home or in a center.
Adult day care services during the day to allow a disabled or elderly adult to function at home or in a center.
Adult foster care see adult care services.
Advance notification the advance notice an employee must give an employer when requesting a leave under the Family Medical Leave Act of 1993 (FMLA).
After-tax contributions contributions to a qualified plan from an employee’s pay after applicable federal, state and local taxes are withheld.
After-tax premiums premium payments taken from an employee’s pay after applicable federal, state and local taxes are withheld.
Age reduction schedule under disability plans, the schedule showing when benefits stop or are reduced when the employee reaches a particular age, or combination of age and number of years disabled.
Allergy testing/treatment testing to determine the allergens to which a participant is allergic, and treatment to reduce sensitivity to that allergen.
Allocation distribution of an amount. For example, an employer contribution may be allocated to the accounts of eligible employees, or a contribution may be allocated among available investment funds.
Allowable amount the part of a provider’s charge that is eligible for reimbursement (full or partial) by a plan.
Alternate payee a spouse or former spouse with an interest in plan benefits under the terms of a Qualified Domestic Relations Order (QDRO).
Alternative care or alternative treatment under some mental health and chemical dependency programs, alternative care is more intensive than outpatient treatment and less intensive than inpatient treatment. Examples may include partial hospitalization, residential treatment or care in a half-way house or group home.
Ambulance a vehicle that transports patients with acute medical conditions and provides paramedic and stabilizing medical services.
Ambulatory care services provided to an outpatient.
Ambulatory care facility a facility providing outpatient services.
Anesthesia local anesthesia involves administering agents to achieve the loss of conscious pain in a specific part of the body. General anesthesia involves administering agents to render the patient completely unconscious and without conscious pain response.
Anesthetic a drug that produces loss of feeling.
Annual enrollment the period of time a company designates each year in which an employee may make changes in enrollment for certain benefits.
Annuitant a person entitled to receive payments under an annuity.
Annuity a contract that provides income in periodic payments for a specific period of time, or payments made under such a contract.
Appliance in dental plans, a device used to provide function or to heal. A fixed appliance is attached to the teeth. A prosthetic appliance replaces a missing tooth.
Appreciation increase in an asset’s value.
Arbitration a process where independent persons, called “arbitrators” reach a decision that is binding upon disagreeing parties.
Asset anything having commercial or exchange value and belonging to a person or organization.
Asset classes classes of investments such as stocks, bonds, and money market instruments.
Assignment assigning benefits to someone else. Generally, qualified plan benefits cannot be assigned to someone other than the employee or other participant. Exceptions include pension benefits affected under a Qualified Domestic Relations Order (QDRO), and some life insurance plans that allow the participant to assign the life insurance policy to someone else.
Assisted living facility shared, supervised residence for those who cannot live independently.
Attained age a person’s age at his or her latest birthday.
Balance billing the practice of charging full fees (over the covered amounts) and then billing the patient for the part of the bill (the balance) that the plan does not cover.
Bargaining contract a contract under which all parties set the terms and conditions of the contract.
Before-tax contributions contributions taken from an employee’s pay before federal and most state and local taxes are withheld.
Before-tax premiums premium payments taken from an employee’s pay before federal and most state and local taxes are withheld.
Beneficiary a person named by the participant to receive insurance or retirement plan benefits when the participant dies. Also, anyone who may receive benefits under an employee benefit plan.
Benefit duration period a disability benefit plan may have a maximum length of time that benefits will be payable. The benefit duration period begins when the person has become disabled as defined under the plan and has met any waiting period, and ends when the maximum length of time to receive benefits is reached.
Benefit package all the benefits offered by an employee benefit plan.
Bereavement leave time taken off work due to a death.
Birth control pills and devices pills and devices designed to prevent conception of a fetus, or to prevent implantation of a fertilized egg.
Birthday rule in plans that follow the birthday rule, if two spouses are each covered by their own employer-provided healthcare plans, the plan covering the parent whose birthday falls first in the calendar year pays benefits first (is the “primary plan”) regardless of which parent is older. If both parents have the same birthday, the plan that has covered the person the longest pays first.
Birthing center some medical plans cover births at a birthing center, which provides prenatal, delivery and postpartum care, is staffed by certified nurse-midwives, and meets the plan’s requirements as well as accreditation and state licensing.
Bitewing a dental x-ray to show the teeth in the halves of the upper and lower jaw that are covered with enamel.
Blood for medical plans that cover blood, the term may include whole blood, blood plasma, and other blood products.
Bond an IOU from the issuer that entitles the holder to a specified sum of money, usually at regular intervals, and repayment of the principal loan amount when the bond matures.
Book value for most assets, the value at which it is carried on the balance sheet. For a bond, the value of an original bond investment, plus interest.
Brand name drug a drug that is patented and produced by only one manufacturer.
Break in service an interruption in employment that affects the employee’s benefits.
Bridgework fixed bridgework is a partial denture held in place with crowns or inlays cemented to natural teeth, and used as an abutment. Fixed-removable bridgework can be removed by the dentist but not the patient. Removable bridgework is a partial denture held in place by attachments, which the patient can remove.
Burial interment of physical remains.
Business travel accident insurance coverage for an accident that occurs while traveling on company business.
Caesarian section childbirth by surgical removal of the baby.
Cafeteria plan an employee benefit plan that gives employees a choice among cash and one or more qualified benefits, such as health insurance, group term life and dental benefits.
Calendar year deductible the deductible that applies for a plan that counts the deductible based on a calendar year.
Call to active duty a summons to active military service.
Cardiac/pulmonary treatment treatment of illness or injury affecting the heart and lungs.
Caries tooth decay.
Carryover deductible a deductible that applies when a participant is eligible for continuation coverage under COBRA due to a “qualifying event” such as divorce or termination of employment. The carryover deductible is the deductible payable under the COBRA continuation coverage and that includes the part of the deductible satisfied before the qualifying event.
Cash balance plan see account balance plan.
Cash equivalents investments, such as money market funds and treasury bills, of such high quality and liquidity that they are considered virtually the same as cash.
Cash or deferred arrangement (CODA) a plan under Section 401(k) of the Internal Revenue Code that allows employees to choose between receiving compensation, and electing to have that compensation contributed on their behalf to a qualified plan.
Cash value or cash surrender value under group universal life insurance and other whole life insurance policies, cash value is the amount the insurer would return to the policyholder if the policy were cancelled. Some policies allow loans against cash values.
Catch-up contributions

For 401(k) plans: Participants age 50 and over may be allowed to make contributions to the plan that are in excess of the annual contribution limit, depending on the rules of the plan. Annual catch-up limit for 2009 is $5,500.

For Health Savings Accounts (HSAs): Participants age 55 or older are permitted contributions to the account that are in excess of the annual contribution limit. Contributions can be made each year until participants become enrolled in Medicare. Annual catch-up limits are:
2005 – $600
2006 – $700
2007 – $800
2008 – $900
2009 and later – $1,000

Center of excellence a facility named as a preferred place to have certain very specialized services performed, such as organ transplants.
Certificate of deposit (CD) an IOU issued by a bank that usually earns interest. It may mature over a few weeks or many years.
Charitable deductions amounts deducted from a paycheck to contribute to charitable organizations.
Chemical dependency both alcoholism and drug dependency as classified by the International Classification of Diseases of the U.S. Department of Health and Human Services.
Chemotherapy treatment of internal disease (primarily cancer) by drugs.
Childbirth the act of giving birth to a child.
Chiropractic care or services services provided by a chiropractor under a system of medicine based on the theory that disease is caused by malfunction of the nervous system, and that normal function can be restored by manipulation and other treatment.
Chiropractor a Doctor of Chiropractic (D.C.) who performs chiropractic services.
Circumcision surgery to remove the foreskin of a newborn male.
Civil litigation a lawsuit in civil, rather than criminal, court.
Claim for healthcare plans, a statement of services rendered by a healthcare provider for a given patient. The claim is submitted to the plan for payment.
Claim form the form used to file for benefits under a health plan.
Claimant the person who files a claim for benefits.
Claims administrator the company that reviews plan claims and determines whether to pay them.
Claims procedure the procedure under the Employee Retirement Income Security Act of 1974, as amended (ERISA) for filing claims under a qualified plan, and for requesting an appeal of denied claims.
COBRA see the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended.
CODA see cash or deferred arrangement.
Codicil an amendment to a will.
Coinsurance a cost-sharing method by which a health insurance plan pays a percentage of the provider’s covered expense (often after a deductible is met) and the participant pays the rest. For example, the plan may pay 80% and the participant may pay 20%. In this case, the 20% is the participant’s coinsurance.
COLA see cost of living adjustment.
Collective bargaining agreement or contract a formal agreement over wages, hours and other conditions of employment entered into between an employer and one or more employee unions.
Commercial paper short-term loans from 2 to 270 days, issued by top-rated organizations and often backed by bank lines of credit.
Common stock units of ownership of publicly traded corporations.
Community leave time off from the job to perform community service.
Company match, company matching contributions see match or matching contributions.
Compensation planning services services to assist in compensation decisions such as whether or not to defer compensation.
Compensatory time cashout overtime hours that are worked, then converted to paid time off, then cashed out rather than taken as time off.
Compound interest interest earned both on the principal investment and also on the previously-earned interest.
Conduit IRA an individual retirement account set up to hold tax-deferred amounts from another employer’s qualified plan.
Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (COBRA) Federal legislation that governs the offer of temporary continued benefit coverage to participants who otherwise would lose coverage for certain reasons, such as termination of employment.
Consumer Price Index (CPI) a measure of inflation based on relative prices at various times of a fixed market basket of goods and services.
Consumer-Driven Healthcare (CDH) Consumer-driven healthcare is characterized by accounts which participants use to fund everyday medical expenses not covered by their healthcare plan. With direct access to dollars to manage and spend on healthcare, employees learn to shop around and spend their money in a cost-conscious manner. These accounts are coupled with high deductible health plans that provide coverage for more serious medical problems. Consumer-driven healthcare also includes the use of online and other information resources, such as calculators and modeling tools, so participants can get the information they need to make healthcare decisions.
Contingent annuitant a person named to receive annuity benefits if the primary annuitant dies first.
Contingent beneficiary the person named to receive death benefits only if no primary beneficiaries are living when the insured person dies.
Continued employment clause a provision that requires an employee to remain employed in order for coverage to continue, or for an employee to be eligible for a contribution.
Controlled group company a company of which the employee’s company directly or indirectly owns 80% or more of the voting stock, or another company that is required to be considered a controlled group company under the Internal Revenue Code of 1986, as amended.
Conversion privileges a privilege given to a participant to convert group insurance to an individual insurance policy, without evidence of insurability, upon termination of employment.
Coordination of benefits (COB) a provision under a group health plan that clarifies the order in which plans will pay if a given person has coverage under more than one plan.
Copayment a flat dollar amount that a participant pays for a certain medical service (such as an office visit) as the participant’s share of the cost. Copayments may apply in addition to deductibles and coinsurance.
Cost of living adjustment (COLA) an across-the-board change in wages or pension benefits to reflect the rise or fall in the cost of living as measured by an index such as the Consumer Price Index (CPI).
Cost-saving features features that reduce costs.
Covered dependent a person other than the employee who is covered under an employee’s healthcare plan.
Covered expense an expense that meets all the rules to be covered by a plan.
Covered person a person who is covered under a plan.
Covered provider a service provider eligible to provide covered services and receive payment under a plan.
CPI see Consumer Price Index.
Credit rating the result of a formal investigation into a person’s or corporation’s credit history, creditworthiness and ability to repay debts.
Credit union a not-for-profit financial institution formed to serve members of a group.
Cremation the process by which physical remains are converted to ash for dispersal or burial.
Critical care healthcare provided to acutely ill patients during a medical crisis, such as in an intensive care unit or coronary care unit.
Crown the part of a tooth covered by enamel.
Custodial care services that could be rendered safely and reasonably by a person without special medical skills, or that are designed mainly to help the patient with daily living activities.
Daily benefit the maximum amount of money a participant will be paid for each day covered services are received.
Death benefit the payment made to beneficiaries upon the death of the participant.
Debenture a bond secured only by the issuer’s promise (not backed by specific collateral).
Debit card Many HRAs and HSAs provide participants with a debit card to access the account funds when paying for services. When a participant receives a healthcare service and presents the card, the card debits the payment from the account. Participants can usually review these card payments online or on paper to keep track of their expenses.
Debt collection defense legal services provided to a legal services plan participant to help deal with the claims of creditors.
Declawing surgical removal of part or all of the claws from a pet, such as the front claws of a cat.
Deductible the amount of eligible expenses the participant may be required to pay each year before the plan begins to pay benefits for covered expenses.
Deductible carryover a feature under some healthcare plans where covered charges incurred near the end of a year (such as in the last three months) may be carried over to be counted toward the next year’s deductible.
Deferred compensation compensation an employee elects to have contributed to a deferred compensation plan rather than receiving it as pay. Such a plan typically defers income tax on the deferred compensation until the employee withdraws it from the plan.
Defined benefit plan a plan that is not an “individual account plan” under the law. A defined benefit plan has a definite formula by which the employee’s benefits will be determined. In plans of this type, employer contributions are determined by actuaries.
Defined contribution plan (individual account plan) a plan that provides for an individual account for each participant and for benefits to be the sum of amounts contributed to the employee’s account, plus any investment return or forfeitures allocated to that account.
Dental hygienist a person trained and licensed to remove deposits from teeth, and to provide other services under the direction of a dentist.
Dental plan a plan designed to help participants with the cost of covered dental services.
Dental services due to accident dental services performed due to an accident that injures teeth or their structures.
Dentist a person licensed to practice dentistry. The term may also mean a physician who is authorized to perform a given dental service.
Denture a device to replace missing teeth.
Department of Labor (DOL) the department that administers the administrative and regulatory portions of ERISA.
Dependent care flexible spending account (dependent care FSA) an employer plan that allows employees to set aside before-tax contributions from their paychecks to pay the cost of care for eligible dependents.
Dependent life insurance insurance covering the life of an eligible dependent, such as a spouse or child.
Diagnostic services services to determine the presence, cause or nature of a disease.
Direct roll-in an amount the employee has transferred directly to the current company’s retirement plan from a former employer’s qualified plan or from a conduit IRA. A direct roll-in contribution generally does not require tax withholding.
Direct rollover a payout of tax-deferred retirement plan money directly from the trustee of a qualified plan to the trustee of another qualified plan or an individual retirement account. A direct rollover does not incur taxes or penalties.
Disability a condition that makes an employee incapable of performing some or all of the duties of his or her job. Plan definitions of disability vary.
Disability insurance insurance against income lost due to the participant becoming disabled as defined by the plan.
Dismemberment the loss, or loss of use of, a limb or function such as vision.
Diversification dividing assets among several different investment types in an effort to reduce risk.
Dividends earnings distributed to shareholders.
DOL see Department of Labor.
Domestic partner, domestic partnership dependent a person who is unrelated to the employee by blood or marriage and is not legally married to the employee. Plans that provide coverage for domestic partners generally require certification of the partner.
Drug Utilization Review (DUR) a system that reviews prescriptions to identify potential interactions with other drugs, and proposes alternative treatments.
Durable medical equipment medical supplies that are not disposable such as wheelchairs, home hospital beds and kidney dialysis equipment.
EAP see Employee Assistance Plan.
Early distribution a distribution taken from a pension plan before the participant reaches age 59-1/2 assuming the participant has not died or become disabled. Early distributions are generally subject to a 10% penalty tax.
Early retirement when a participant retires after becoming eligible for a pension benefit but before reaching normal retirement date. Generally, the early retirement pension is a reduced percentage of the normal retirement pension.
Early retirement date the earliest date a retirement plan participant may begin to receive benefits.
Educational assistance program a plan that allows employers to provide employees with tax-free assistance for eligible education expenses.
Effective date the date coverage or plan participation begins.
Elapsed time method a way of counting a participant’s service that involves subtracting the hire date from the termination date.
Elder care support for participants and their disabled or elderly relatives. This can include referral services and adult day care.
Elective care care that can be postponed for the number of days defined by the healthcare plan without undue risk to the patient.
Eligibility period the period of time that eligible participants can enroll in, without providing evidence of insurability.
Eligible adoption leave time off due to adoption or placement of a child for adoption.
Eligible compensation the part of an employee’s pay used to determine a pay-based benefit.
Eligible dependent a person other than the employee who is eligible to be covered under an employee’s plan.
Eligible employee an employee who is eligible to be covered under a plan.
Eligible expenses expenses that meet all requirements to be covered under a plan.
Eligible rollover distribution the part of a retirement plan payment that can be rolled over to an individual retirement account or to another qualified plan that accepts rollovers. Does not include dividends from an Employee Stock Ownership Plan, or after-tax contributions to a 401(k) plan.
Elimination period (waiting period) the period of time an eligible participant must complete before being eligible to be covered under a plan. For a disability benefit, this is the period of time the person must be disabled as defined by the plan before disability benefits begin.
Emergency and short term child care services employer-supported services designed to provide temporary care for a child when the child’s regular caregiver becomes unavailable.
Emergency care care in an emergency as defined under a healthcare plan. The plan’s rules for preauthorizing care or for using network providers may be less strict in an emergency. Characteristics of an emergency often include sudden onset and symptoms severe enough that the lack of immediate attention could seriously harm the patient or cause severe pain. Mental health and chemical dependency plans often include potential harm to the patient or others in the definition of an emergency.
Emergency medical evacuation emergency removal of a patient from one place to another for treatment (such as by helicopter) when either the patient’s condition or the patient’s location or situation do not permit timely transport by ambulance.
Emergency room a hospital area equipped and staffed for the prompt treatment of acute illness, trauma, and other medical emergencies.
Employee Assistance Plan (EAP) an employment-based plan designed to help employees cope with issues such as work/life balance, stress, family violence and grief. The plan may offer employees counseling assistance by telephone, and may also cover follow-up visits with counselors if needed.
Employee contribution This is the amount an employee contributes toward an HSA. (Employees are not permitted to contribute to an HRA).
Employee coverage Coverage that protects the employee only.
Employee Retirement Income Security Act of 1974, as amended (ERISA) a sweeping federal statute that regulates most of the private benefit plans in the U.S.
Employee Stock Ownership Plan (ESOP) a type of plan that encourages employees to own employer stock by distributing benefits in shares of stock.
Employer contribution The amount an employer contributes toward an employees HSA or HRA.
End stage renal disease the stage of kidney dysfunction that is nearly always permanent, in which the patient needs dialysis or a kidney transplant to survive.
Endodontic therapy (root canal) treatment of a tooth with damaged pulp. This may involve removing the pulp, sterilizing the pulp chamber and root canals, and filling those spaces.
EOB see explanation of benefits.
EOI see evidence of insurability.
Equities ownership of property, usually stock.
ERISA see Employee Retirement Income Security Act of 1974, as amended.
ESOP see Employee Stock Ownership Plan.
Estate planning financial planning services to help participants plan for the transfer of their assets after their deaths. Goals may include reducing estate taxes and providing for the participant’s wishes.
Euthanasia painless putting to death, or allowing to die, typically of a pet.
Eviction defense legal services to help participants defend against being evicted from their homes.
Evidence of insurability (EOI) proof of health, employment or other factor required before beginning or increasing insurance amounts.
Exclusion something that is specifically not covered under a plan.
Exclusion allowance a way to calculate how much compensation a participant can exclude from income and contribute to a tax sheltered annuity.
Executive retirement planning retirement planning services for executives. May involve planning to accumulate assets for retirement or to time a retirement plan distribution.
Exercise period for stock options, the exercise period refers to the period of time during which the owner of the options can use those options.
Exercise price for stock options, the price at which the holder has the right to convert the options to stock.
Exercise programs fitness programs generally for improvement of health.
Experimental or investigative treatment, drug or device services and supplies not commonly approved by applicable government agencies, and not commonly accepted as standard practice at the time the service is given.
Explanation of benefits (EOB) after a claim is filed with a healthcare company, the healthcare company sends this statement to the participant showing payment information for each service or supply received under the plan.
Extended care facility an institution other than a hospital that provides inpatient medical services. Such a facility provides medical treatment and is not primarily for custodial care.
Eye exams examinations to diagnose vision problems and determine a corrective prescription. May also include health screening for conditions such as glaucoma.
Eyeglasses lenses in frames for vision correction.
Fair market value price at which an asset or service changes hands, assuming an informed buyer and seller.
Family coverage Health coverage that covers the employee and other family members.
Family deductible a deductible met by the combined expenses of all covered family members.
Family Medical Leave Act of 1993 (FMLA) an act that requires companies with more than 50 employees to provide up to 12 weeks of unpaid, job-protected leave for eligible employees who meet the service requirements and request leave for birth, adoption, foster care placement, and illness of the employee or a family member.
Fertility programs treatment designed to increase the ability to conceive a baby, or to induce conception.
First dollar coverage This is insurance coverage that pays the entire covered amount without requiring a deductible to be satisfied first. The high deductible health plans used as part of consumer-driven healthcare generally do not offer first dollar coverage, although some plans may provide it for preventive care services.
Fiscal year a corporation’s accounting year, which may or may not be a calendar year.
Fixed bridge a device to replace a missing tooth or teeth that is cemented in the mouth. A fixed bridge is made up of one or more pontics held by one or more retainers attached to the abutment teeth.
Fixed income steady income such as that from bonds, fixed annuities, or preferred stock.
Fixed match or fixed matching contributions the fixed amount a company contributes to the employee’s 401(k) account based on the employee’s matched contributions.
Flexible benefit plan a plan under Section 125 of the Internal Revenue Code that gives employees a choice between taxable benefits, including cash, and nontaxable benefit programs. Employees typically have say in the election of benefits, and may be able to add employee contributions for increased benefits.
Flexible spending account (FSA) an account set up under an employer plan that allows employees to set aside pre-tax dollars from their paychecks to pay eligible expenses. There are two forms of flexible spending accounts: healthcare and dependent care.
Fluoride a fluoride solution applied to teeth to prevent dental decay.
FMLA see Family Medical Leave Act of 1993.
Foreign (or international) fund an investment fund that invests only in non-U.S. securities. Compare this to a global fund, which invests in both U.S. and foreign securities.
Foreign affiliate an entity in which an employee’s company has a direct or indirect ownership of at least 10% and has entered into a 3121(l) agreement under the Internal Revenue Code.
Forfeiture an amount an employee loses by terminating employment before becoming fully vested under the plan’s vesting schedule. In flexible spending accounts, the amount an employee loses if any money remains in the account after the claims filing deadline.
Formulary a list of prescription drugs that are approved for use in specific treatments and dispensed through network pharmacies to plan members. Plans may charge more for drugs not on the formulary, or may not cover them at all.
FSA see flexible spending account.
Generic drug a drug that does not have the trademark of the original manufacturer. It is chemically identical to and generally costs less than its brand name counterpart.
Global fund an investment fund that invests in both U.S. and foreign securities. Compare this to a foreign fund, which invests only in non-U.S. securities.
Grandfathered provisions when a company changes a benefit plan, participants who were active participants in the plan before the change may remain covered under some provisions of the old plan, or may be given an option between the old provisions and the new provisions. The provisions of the old plan that carry forward for such participants are grandfathered provisions.
Grant a grant generally refers to a grant of employer stock, or of options to purchase employer stock.
Group homes living places that provide an environment for mental health and chemical dependency treatment, and help the residents ease their way into regular activities.
Group universal life plan (GULP) group life insurance that combines two features: death benefit protection for named beneficiaries through term insurance, and an investment element that can create permanent insurance or accumulate money tax-deferred. Participation is voluntary and the employee pays the full cost.
Guaranteed issue amount the amount of life insurance an individual can purchase for which no medical examination or health history is required.
Halfway houses living places that provide an environment for mental health and chemical dependency treatment, and help the residents ease their way into regular activities.
Hardship withdrawal a withdrawal of employee contributions from a 401(k) plan before the participant retires at age 55 or reaches age 59-1/2 and after meeting the plan’s tests for financial hardship. Such a withdrawal is subject to ordinary income tax and a 10% penalty tax.
HCE see Highly compensated employee.
HDHP see High Deductible Health Plan.
Healthcare flexible spending account (healthcare FSA) an account an employee may establish to set aside before-tax contributions from each paycheck to pay eligible healthcare expenses.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) legislation that improves the availability of health insurance by restricting preexisting limitation clauses for those who change jobs, providing special enrollment rights to employees, and requiring data privacy and security of personal health information.
Health Maintenance Organization (HMO) a network of hospitals, doctors and other medical providers who provide services through an HMO plan.
Health Reimbursement Arrangement (HRA) An HRA is a fund that an employer sets up for its employees, which is used to reimburse employees for eligible healthcare expenses not covered by the employers health plan. HRAs may be designed to cover any or all of the following expenses: coinsurance, copayments, deductibles, dental and vision charges, and premiums for health and long term care insurance coverage. Funds may also be rolled over from one year to the next, depending on plan design.
Health Savings Account (HSA) An HSA is a personal account that an individual can establish to reimburse the individual for eligible healthcare expenses not covered by his or her health plan. Those expenses that can be reimbursed are those considered “qualified” by the IRS and include: coinsurance, copayments, deductibles, dental and vision charges. An individual must be enrolled in a high deductible health plan in order to establish an HSA. Once the individuals expenses meet the plan deductible, the remaining eligible expenses are covered by the high deductible health plan according to its rules. Employees and employers may contribute to the HSA. Funds that are not spent in any year can roll over to subsequent years and allow the participant to save for future expenses.
Hearing therapy/hearing aides treatment or equipment to improve hearing.
High Deductible Health Plan (HDHP) A plan with a large deductible, typically at least $2,000. They are designed to treat extraordinarymedical expenses and not everyday expenses. An individual must be enrolled in a high deductible health plan in order to establish an HSA.
Highly compensated employee (HCE) an employee who earns more than a specific dollar amount established by the IRS. This dollar amount is adjusted from time to time for cost of living changes.
HIPAA see Health Insurance Portability and Accountability Act of 1996.
HMO see Health Maintenance Organization.
Home healthcare some medical plans cover home healthcare that meets certain requirements. For example, such care may require precertification, a written treatment plan, and may require care to be provided by persons meeting certain requirements.
Home healthcare agency an agency licensed by the state and accredited to provide services such as skilled nursing during visits to the patient’s home.
Homeowner insurance insurance on the value of the home and its contents.
Hospice an organization licensed by the state to care for terminally ill patients.
Hospital an organization licensed by the state to provide inpatient and outpatient care for diagnosis and treatment of illness and injury. It is not primarily for rest or custodial care.
Hours of service hours for which the employee is paid, or entitled to be paid, by the company.
HRA see Health Reimbursement Arrangement.
HSA see Health Savings Account.
Identity disorder generally refers to a confusion of gender identity, where a person confuses the sense of being male and masculine or female and feminine.
Immunizations the process of making a person immune to a disease, generally by injection.
Impression a negative reproduction of a given area. For example, an impression may be taken of a tooth in order to make an inlay or crown for that tooth.
In-network when the participants choose to receive care from providers who participate in a network under the plan, this is considered receiving care “in-network.” Some plans have a “gatekeeper” who must authorize all care to have that care covered at in-network levels under the plan.
In-service withdrawal a withdrawal from a plan account while the employee is working for the company.
Indemnity plans group health insurance plans that generally allow the patient to use any covered provider for plan services. Generally, the participant pays the full cost of services until a deductible is met, then the participant and the plan share the costs.
Index fund an investment fund that holds investments that mirror the investments tracked by a major index, such as the Standard and Poor’s 500.
Individual deductible the deductible that must be met by an individual participant.
Individual retirement account (IRA) an account that allows individuals to set aside money for retirement. Income limits, and whether they are covered under another qualified retirement plan, determine whether contributions can be made pre-tax. Investment return is tax deferred until withdrawal. Ordinary income tax must be paid upon withdrawal, as well as a 10% penalty tax on amounts withdrawn before age 59-1/2.
Individual underwriting a process of determining an applicant’s individual eligibility for insurance. This differs from group underwriting, where newly eligible plan participants generally are not reviewed on an individual basis for insurability.
Infant age increase schedule some dependent life insurance programs increase the insurance coverage amount for infants at different ages. For example, one coverage amount may be available from birth to two days, another until the end of two weeks, and another beyond age two.
Inflation protection a feature to adjust benefits to reflect changes in the cost of living as measured by an index.
Informal care in a long-term care plan, informal care is generally assistance with basic living needs that does not need to be provided by a specially-trained person or in a formal setting.
Inlay a restoration made to fit a prepared tooth cavity and then cemented into place.
Inpatient a patient confined in a hospital or other healthcare facility as a registered bed patient for the number of hours defined by the plan, and who incurs room and board charges.
Inpatient care care received while an inpatient.
Inpatient facility a facility (such as a hospital) that provides inpatient care.
Inpatient surgery surgery performed while a person is an inpatient in a hospital (a registered bed patient incurring room and board charges).
Integration with Social Security a plan where the benefits are integrated with the Social Security benefit. With an integrated plan, employees earning more than the Social Security taxable wage base receive greater contributions to reflect the fact that Social Security benefits are not provided based on pay over that amount.
Interactive voice response an interactive phone system that provides benefit information and/or accepts transactions.
Intermediate care for a long-term care program, the level of care that lies between the skilled care that would be provided in a hospital or skilled nursing facility, and purely custodial care.
Intermittent leave a form of leave under the Family Medical Leave Act taken in separate blocks of time (not as one continuous leave of absence).
International fund an investment fund with at least two-thirds of its assets invested in equities of companies outside the U.S.
Intestate a person dies intestate when he or she dies without a will.
Investment use of money in an effort to create more money.
Investment management services services to allocate assets among various available investments.
Investment option A financial vehicle that is used to invest the funds of a participant. Health Savings Accounts (HSAs) allow the individual to invest the account funds in various options: typically, some type of cash or savings account, bonds, stocks or mutual funds.
IRA see individual retirement account.
IVR see interactive voice response.
Joint and 100% survivor annuity the automatic payment method under some retirement plans if the employee is legally married when benefit payments begin. It provides the employee with monthly payments for life, reduced based on the ages of both the employee and the spouse when payments begin. If the employee dies before the spouse, the employee benefits will stop and the spouse will receive 100% of the reduced payments for life.
Joint and 50% survivor annuity the automatic payment method under some retirement plans if the employee is legally married when benefit payments begin. It provides the employee with monthly payments for life, reduced based on the ages of both the employee and the spouse when payments begin. If the employee dies before the spouse, the employee benefits will stop and the spouse will receive 50% of the reduced payments for life.
Junk bond bond with a credit rating of BB or lower by key credit agencies.
Jury duty time off from work when called to serve on a jury.
Keogh (HR-10) plan a pre-tax retirement savings program for small-business owners and self-employed people. Keogh plan participants postpone tax on both contributions and earnings while their money remains in the plan.
Kidney disease, end-stage failure of the kidneys. A person with end-stage kidney disease qualifies for Medicare before reaching the usual Medicare eligibility age of 65. A Medicare-eligible participant should review how Medicare works with any employer-sponsored healthcare coverage.
Lawful spouse a person recognized as the lawful husband or lawful wife of an active employee under the laws of the state or jurisdiction where the employee lives.
Leave year the twelve-month period a company uses for measuring leave taken under the Family Medical Leave Act.
Liability insurance insurance that pays benefits to an injured party on behalf of a covered party that is legally responsible for the harm to that person or property.
Lifetime maximum the most a plan will pay in benefits for a covered person.
Limit a minimum, maximum, or other limitation.
Limitation see limit.
Living needs benefits or living benefits a life insurance plan may give policyholders access to part or all of their insurance benefit while still living, such as if they become terminally ill.
Living trust a trust established while the donor of the trust assets is alive (as opposed to a testamentary trust, that is established at death).
Living will a document that instructs doctors on wishes about issues such as use of life support systems and pain relieving medication for a person who has a terminal condition.
Loan an amount borrowed under plan rules.
Long-term care services needed by people with chronic health conditions.
Long-term care insurance coverage to pay part or all of long-term care costs.
Long-term disability a significant period of disability as defined by a long-term disability plan.
Long-term disability (LTD) plan a plan designed to provide disability benefits to an employee after the employee meets the plan’s disability requirements and waiting period, until the employee is no longer disabled or reaches the age limit for benefits.
Loss of a body part or function a loss as defined by an accident plan. For example, for the plan to pay upon “loss of a hand,” the plan may require that the hand be completely severed at or above the wrist joint.
LTD plan see long-term disability (LTD) plan.
Lump-sum distribution payment of an employee’s entire vested benefit from a retirement plan after leaving the company in a single sum. Depending on the type of plan, this may be the vested account balance or the present value of a future vested benefit. Not all plans allow a lump-sum benefit at termination.
Mail-order drug program filling of prescriptions by mail through a mail-order pharmacy. Plans often offer substantial savings for mail-order prescriptions, especially for long-term therapy such as blood pressure medication.
Malocclusion an abnormal relation to the opposing teeth (sometimes also called “bite”).
Malposition faulty position of teeth.
Managed care healthcare cost containment through coordination of care through primary providers, use of provider networks, utilization review, preauthorization of services, and other means.
Match or matching contributions the amount a company contributes to the employee’s 401(k) account based on the employee’s matched contributions.
Matched contributions contributions an employee makes to a 401(k) plan that are eligible for matching contributions by the company.
Maternity motherhood.
Maternity care maternity care may include prenatal care (exams during pregnancy), childbirth, certain routine nursery care for a newborn, and postpartum care.
Maximum annual benefit the maximum dollar amount of benefits a plan will pay for a given person in a year.
Maximum lifetime benefit the maximum dollar amount of benefits that will be paid for a given person under a plan.
Medical certification the documentation that may be required when an employee requests a leave under the Family Medical Leave Act for medical reasons.
Medically necessary care that meets the plan’s requirements of medical necessity. The definition often includes that the care must be appropriate, based on recognized standards of care, and not experimental or investigational.
Medicare a federal plan administered by the Social Security Administration to pay certain medical expenses for those who qualify.
Mental and nervous disorders see mental illness.
Mental health and chemical dependency professionals caregivers with the education, certification, and licensing required by the mental health and chemical dependency plan.
Mental illness a condition meeting the plan’s definition of mental illness. This may include reference to the International Classification of Diseases by the U.S. Department of Health and Human Services, or to generally accepted standards.
Money market the general market for short-term debt instruments including commercial paper, Treasury bills and CDs. A money market fund invests in these instruments.
Money purchase plan a type of individual account plan in which the employer’s contributions are made for specific individuals as defined by the plan (usually as a percentage of pay). Benefits are determined based on the amount that can be purchased with the money in the participant’s account from contributions and investment return.
Morbid obesity obesity that has become a direct and immediate threat to a person’s life.
Mutual fund a fund created by an investment company by raising money from shareholders and investing it in an effort to meet the fund’s objectives. Mutual funds generally offer greater diversification, lower risk, and lower management fees for a given amount invested than investing the same amount in a single stock or bond.
Negotiated fees the fees negotiated between a network and its providers. Generally, the providers agree to accept fees lower than those typically charged by doctors and hospitals.
Network a group of providers in a given area who contract with a healthcare plan to provide care at discounted rates.
Neuter to alter a pet by spaying a female or castrating a male.
No-load fund a mutual fund that charges no sales charge to its shareholders.
Nonassignability generally, qualified plan benefits cannot be assigned to someone other than the employee or other participant. Exceptions include pension benefits affected under a Qualified Domestic Relations Order (QDRO), and some life insurance plans that allow the participant to assign the life insurance policy to someone else.
Nonformulary drugs that do not appear on the plan’s formulary list.
Normal retirement age under a retirement plan, the normal age for full benefits to begin. Since full Social Security benefits are currently available at age 65 for most retirees, although it will gradually rise to age 67 in 2027, age 65 is often the normal retirement age.
Normal retirement date under a retirement plan, the normal date for full benefits to begin. It may be based on a number of years of age or a combination of age and service.
Notice period the lead time a company requests before a leave under the Family Medical Leave Act can begin.
Nursing home a licensed facility that provides skilled nursing care but does not meet Medicare’s definition of a “skilled nursing facility.”
Nutritional counseling some medical plans cover nutrition education and planning for a duly certified nutritionist to help manage a newly diagnosed or newly deteriorating medical condition such as diabetes that may be partially controlled by diet. Such counseling is generally not covered for general health or wellness, or weight loss or gain objectives that are not associated with a diagnosed illness.
OASDHI see Old-Age, Survivors, Disability and Health Insurance.
Occupational illness or injury health problems caused by work or work conditions.
Occupational therapy treatment after illness or injury to increase a patient’s use of fine motor skills needed in daily living.
Office visit a personal visit between a physician and a patient in an office or hospital.
Old-Age, Survivors, Disability and Health Insurance (OASDHI) U.S. Social Security benefits.
Onlay a restoration that covers the entire biting surface of a tooth, such as to replace a lost part of a tooth or to improve occlusion (bite) by increasing the height of a tooth.
Open enrollment the period of time a company designates each year in which an employee may make changes in enrollment for certain benefits.
Open matter in legal services plans, an open matter is a matter on which a participant has consulted an attorney and the attorney has begun to represent the participant.
Option a contract giving the holder the right (but not the requirement) to exercise an option to buy or sell at a particular price. Employers sometimes grant stock options to employees giving them the right to buy employer stock at a given price (the exercise price).
Oral surgery surgery of the mouth, such as removal of an impacted wisdom tooth.
Organ donation the donation of an organ or bone marrow from a living or dead person. Costs for the donor and the recipient may or may not be covered under a medical plan. Such services generally require preauthorization, and may need to be performed at a special center, sometimes called a Center of Excellence.
Orthodontics, orthodontia dentistry to detect, prevent, and correct abnormalities of the position of teeth (straightening teeth).
Orthotics medical equipment designed to support a weak or nonfunctioning body part.
Other coverage To establish an HSA, participants cannot have “other coverage” such as being covered under a spouses plan, or other individual coverage. The only coverage they can have is under a high deductible health plan (HDHP). However, a participant can be covered under dental, vision or long term care coverage, or coverage that pays a fixed dollar amount for a disease or for a period of hospitalization, and still establish an HSA; these items are not considered “other coverage.”
Out-of-area benefits for healthcare plans featuring in-network and out-of-network benefit levels, the out-of-area benefits are those available to participants living outside the network’s service area.
Out-of-network care care provided by a healthcare provider who does not participate in a healthcare company’s network.
Out-of-network provider a healthcare provider that does not participate in a healthcare provider’s network.
Out-of-pocket maximum A participants out-of-pocket costs under a health insurance plan refer to those costs for which an employee is not reimbursed through the insurance. Generally, this includes the deductible, copayments, coinsurance amounts and costs that exceed the plans reasonable and customary charges. Health insurance plans have a cap, referred to as the out-of-pocket maximum, that limits the amount of out-of-pocket expenses that a participant has to pay each year. High deductible health plans that work with an HSA are subject to specific out-of-pocket limits: $5,950 for employee coverage and $11,900 for family coverage in 2010 (limits change annually).
Outpatient a patient who is treated in a hospital or other healthcare facility for fewer than the number of hours defined by the plan for an inpatient, and who does not incur room and board charges.
Outpatient care care provided to an outpatient (not overnight care).
Outpatient diagnostic services/treatment care to diagnose injury or disease provided to an outpatient.
Outpatient facility a treatment or diagnosis facility that is licensed and staffed but does not provide overnight inpatient care. Examples include laboratories, outpatient surgical centers, birthing centers, urgent care facilities and outpatient rehabilitation facilities.
Outpatient surgery surgery performed on an outpatient.
Overbite the vertical overlap of the upper teeth over the lower teeth.
Overjet the horizontal overlap of the upper teeth over the lower teeth.
P.S. 58 costs the annual cost of life insurance protection provided by a retirement plan that is included in a participant’s taxable income.
Paid-up life insurance life insurance protection that has been paid in full, with no additional premiums required to continue it.
Parenting education education to improve parenting skills.
Partial denture a device to replace some, but not all, natural teeth, to be supported by the teeth or gums. It may be removable or fixed and on one or two sides.
Partial disability a disability that prevents a person from performing some of the functions of his or her regular job.
Participating pharmacy a pharmacy participating in the plan’s network.
Paternity fatherhood.
Payment method for a retirement plan, the method the participant selects for receiving plan benefits.
Payout events events at which retirement benefits are payable. These could include disability and death as well as retirement or other termination of employment.
PBGC see Pension Benefit Guaranty Corporation.
PCP see primary care physician.
Pedodontics dentistry for children.
Pension periodic payments.
Pension Benefit Guaranty Corporation (PBGC) an entity established under ERISA to guarantee certain benefits for participants in defined benefit plans of companies with over 25 participants.
Pension plan a type of retirement plan that provides a set amount of benefit, or a set formula to determine the amount of benefit. The contributions needed to provide the specific benefits can be determined actuarially.
Periapical the surrounding of the tissues and bony sockets of the teeth.
Periodontics dentistry dealing with the periodontium.
Periodontium the bone and tissues supporting the teeth.
Permanently and totally disabled disabled as defined by a plan in a manner that is expected to continue for life.
Personal leave time off from work for personal reasons.
Pet insurance health insurance for pets.
Physical therapy treatment after illness or injury to increase a patient’s use of large-muscle motor skills needed in daily living.
Physician a doctor licensed by a state to practice medicine. Some plans cover the services of providers who are not physicians.
Podiatry care of the foot.
Point-of-service (POS) plan a type of medical plan that generally provides a higher level of coverage, and may require less paperwork, when the participant coordinates care through his or her primary care physician (PCP).
Policy loan loan from an insurance company secured by a policy’s cash value or cash surrender value.
Pontic the part of a fixed bridge suspended between the abutments and which replaces a missing tooth or teeth.
Portability the ability to keep a benefit policy in force after termination of employment, or to retain a vested retirement plan benefit.
POS plan see point-of-service plan.
Post-tax see after-tax.
Postretirement increases adjustments in pension benefits after retirement, such as cost of living adjustments.
PPO see preferred provider organization.
PPO plan see preferred provider organization (PPO) plan.
Pre-existing conditions conditions that existed before the participant’s coverage began. Some plans do not pay benefits for pre-existing conditions.
Pre-retirement survivor annuity protection that provides the employee’s spouse with a monthly annuity if the employee dies after leaving the company but before benefits begin.
Pre-tax contributions see before-tax contributions.
Pre-tax premiums see before-tax premiums.
Precertification the process by which a medical plan participant seeks advance review of certain types of care and learns what benefits the plan would pay. Some plans require precertification for certain types of care, such as surgeries. Such plans may limit coverage, or even deny benefits, if this precertification is not obtained.
Predetermination limit some dental plans suggest that the participant and the dentist file a “predetermination of benefits” for planned dental care expected to cost more than a certain amount. The suggested amount is the predetermination limit. This tells the participant in advance how much the plan will cover, and advises the patient of alternative forms of treatment.
Predetermination of benefits a participant and a dentist file a “predetermination of benefits” for planned dental care expected to cost more than a certain amount. The suggested amount is the predetermination limit. This tells the participant in advance how much the plan will cover, and advises the patient of alternative forms of treatment.
Preferred provider a provider who has a contract with the plan to participate in the network. The contract includes provisions to accept the reasonable and customary charge or allowable amount for a given service as the full fee.
Preferred provider organization (PPO) a network of medical care providers who have agreed to provide services at negotiated rates and have a contract with the plan.
Preferred provider organization (PPO) plan a type of medical plan that features a network of preferred providers. When you elect to receive care from providers in the network, the plan generally provides a higher level of coverage, and may require less paperwork.
Preferred stock stock that pays specified dividends, and has preference over common stock in dividend payment, and in payment if the corporation goes bankrupt. Unlike common stock, preferred stock generally does not carry voting rights.
Prenatal and early parenthood education education about pregnancy and parenting a young child.
Prescription drugs drugs dispensed by written direction of an authorized person.
Present value the value today of a future payment, or stream of payments. This is determined by discounting the future amount at some rate of interest.
Preventive care care that is intended to prevent the onset of a condition rather than treat an existing condition, such as routine healthcheckups, routine well child care, and immunizations.If a high deductible health plan is used with an HSA and covers preventive care, the IRS permits the plan to cover preventive care services before the participant meets the deductible.
Preventive dental services care to maintain oral health. May include examinations, cleaning, and bitewing x-rays.
Primary beneficiary a person named by the participant to receive insurance or retirement plan benefits when the participant dies. If no primary beneficiaries are living when the insured person dies, benefits will be paid to the contingent beneficiary.
Primary care physician (PCP) some plans require a participant to name a primary care physician?usually a family doctor, internist or pediatrician?to coordinate all medical care. The PCP manages the participant’s healthcare by serving as a main caregiver, and when necessary by referring the participant to another network provider for care. Some plans allow women to name one primary care physician for most care as well as an Ob/Gyn.
Prime rate the interest rate large U.S. commercial banks charge their best customers.
Private duty nursing services provided in the patient’s home by a private duty nurse who is licensed and certificated.
Probate presentation of a person’s will to a court, and appointment of an executor or administrator to carry out the court’s instructions. In other words, the process of settling a person’s estate after death.
Profit-sharing plan an individual account plan a company provides to allow employees or their beneficiaries to participate in its profits. The plan must have a set formula for allocating the contributions among the participants.
Prophylaxis cleaning of teeth by a dentist or dental hygienist to remove tartar and stains.
Prospectus the legal document that shows the history, objectives and status of a security issue.
Prosthesis for medical plans, a device designed to partially compensate for the loss of a body part, such as an artificial arm, leg, eye, or portion of an internal bodily organ. For dental plans, an artificial replacement of one or more natural teeth or associated structures.
Prosthetics an artificial substitute for a missing body part.
Prosthodontics appliances to restore oral function.
QDRO see Qualified Domestic Relations Order.
QMCSO see Qualified Medical Child Support Order.
Qualified beneficiary participants who are eligible for group health plan continuation coverage under COBRA due to their participation on the day before a qualifying event.
Qualified Domestic Relations Order (QDRO) a court action that requires payment of part or all of an employee’s retirement benefits to be paid to meet a property settlement agreement, alimony, or child or dependent support payments, and that is determined to be “qualified” under the Internal Revenue Code of 1986.
Qualified Medical Child Support Order (QMCSO) a court action that requires coverage for a participant’s child, and that is determined to be “qualified” under the Internal Revenue Code of 1986.
Qualifying event an event that entitles a participant to continue, under COBRA (the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended), group health coverage that would otherwise end. Examples include termination or change of employment for the employee or spouse, annulment or divorce, or death of a covered employee.
Radiology x-rays.
Real estate ownership in buildings and land, as well as rights to the air above and the earth below.
Reallocation redistributing assets among options.
Reasonable and customary charge the fee for a product or service that is usually charged most patients for a similar service performed by similar providers within a geographic area.
Reduced-hour leave some companies’ FMLA policy allows an employee to return to work from an FMLA leave on a part-time basis, or to take the FMLA leave as a reduction in the number of hours worked per day or per week.
Rehabilitation services such as those provided by a physical, speech or occupational therapist as part of recovery from injury or illness. This may also refer to long-term disability plans that continue some financial assistance while a person seeks rehabilitation.
Reimbursement account see flexible spending account.
Religious leave time off an employee takes for religious reasons.
Renter’s insurance property/liability insurance for a renter’s goods.
Residential treatment a type of care provided under some plans. Care is provided 24 hours a day, under the supervision of medical professionals, and is generally less intense than the care provided in a hospital.
Respite care short-term care provided in a patient’s home to give the primary caregiver time off, or short-term child care to provide a break for a parent.
Restoration for dental plans, any inlay, crown, bridge, partial or complete denture to restore or replace teeth or tissue. The term applies to the end result of repairing and restoring structure and function.
Restorative services for a dental plan, services to restore healthy teeth, such as fillings, inlays and onlays.
Restorative surgery surgery to restore an area seriously injured in an accident, to correct a birth defect that causes a functional disability, or to restore breast tissue which was surgically removed in response to an illness. Where there has been breast disfigurement for a female participant or covered dependent due to illness, surgery or mastectomy, legislation requires certain plans to cover reconstructive surgery on the other breast.
Roll-in contribution a distribution an employee received from a former employer’s qualified plan, or withdrew from a conduit IRA, and deposited in a qualified retirement plan with the current company that accepts rollovers.
Rollover payment of all or part of an eligible rollover distribution from a plan to an IRA or to another employer’s qualified plan that accepts rollovers.
Root canal see endodontic therapy.
Salary replacement percentage some plans, such as disability benefit plans, are designed to replace a percentage of the participant’s salary.
SAR see summary annual report.
Savings plan see 401(k) plan.
Scaling the removal of calculus (tartar) and stains from teeth using dental instruments.
SEC see the Securities and Exchange Commission.
Second opinion a second physician’s opinion concerning the need for a service, such as surgery, recommended by your physician. This may also include a third physician’s opinion if the second opinion conflicts with the first opinion.
Secondary beneficiary see contingent beneficiary.
Securities and Exchange Commission (SEC) the organization of the U.S. government that administers laws dealing with securities and protection for investors.
SERP see Supplemental Executive Retirement Plan.
Service the company may use an employee’s service to determine eligibility for benefits, vesting, or benefit amounts.
Service area for a plan featuring networks of providers, the geographic area serviced by the network.
Sex change medical procedures to change a male to a female or a female to a male.
Short-term investment an investment that matures in one year or less.
Short-term military service military service by a participant that is considered short-term by the plan.
Sick child care special day care designed for children sick enough that their usual care provider will not accept them.
Sick leave time off, generally paid in full, due to illness or injury. Generally sick leave is for a certain maximum number of days, and may be followed by short-term and long-term disability benefits.
Sick leave cashout some companies allow an employee to cash out accrued but unused sick leave at the end of a year, or at termination of employment.
Single coverage health coverage that covers the employee only; also called employee coverage.
Single life annuity a form of retirement benefit that provides monthly payments to the employee for life, with no benefits payable after the employee dies. For some plans this is the automatic form of benefit for single employees, and available to married employees with the spouse’s signed, notarized consent.
Skilled care 24-hour nursing or rehabilitative care that can only be provided under the direction of skilled medical professionals.
Skilled nursing facility a facility that is licensed and accredited to provide inpatient skilled nursing care.
Social leave see community leave.
Social Security federal program of old age and survivor benefits covering most employees and their eligible dependents. The benefits are paid by the OASDHI.
Social Security integration see integration with Social Security.
Social Security offset some programs, including some pension and long-term disability plans, are designed to provide a certain level of total benefit, including expected Social Security benefits.
Spay surgical altering of a female pet to remove the ovaries and uterus.
SPD see Summary Plan Description.
Speech therapy treatment after illness, injury or birth defect to restore a patient’s communication abilities.
Spousal consent if a married participant under a qualified retirement plan wants to elect a form of benefit other than the automatic form, or to name a beneficiary other than the spouse, this requires signed consent from the spouse, witnessed by a notary public or a plan representative.
Spousal IRA an individual retirement account that can be established for a non-working spouse.
Status change

changes that, under federal regulations, permit an employee to make corresponding changes in enrollment for certain benefits at times other than the annual open enrollment period. Such changes include a change in:

> Eligibility (a child reaches the limiting age for coverage, gets married or leaves school)
> Employment (beginning or termination of employment or change in work schedule by the employee, a spouse or child)
> Marital status (marriage, death of spouse, divorce, legal separation or annulment)
> Number of family members (birth, adoption or placement for adoption, or death)
> Residence or worksite (to move outside a plan’s service area)

Stock ownership in a corporation, held as shares that are each a claim against the corporation’s assets and earnings.
Stock options options to buy or sell stock at a particular price called the exercise price for a specified period of time (called the exercise period). When a company grants stock options to its employees, the exercise price is generally at or below the market price at the time the options are granted.
Stock purchase plan a qualified stock purchase plan is an organized program for employees to buy shares of company stock. It may allow employees to set up periodic deductions to purchase stock, and/or may allow them to purchase additional shares with dividends. The employer may contribute, or offer stock at a fixed price (usually below market value). A nonqualified program allows select employees to purchase stock. They must meet eligibility requirements and hold the stock for a set period of time.
Stock rights see stock options.
Stock split an action by a corporation that results in more outstanding shares of its stock but does not change ownership. For example, if there are 10 million shares outstanding and the stock is trading at $50 per share, a 2-for-1 stock split would result in 20 million shares outstanding at $25 per share. A person who held 5 shares valued at $250 before the split would hold 10 shares, still valued at $250, after the split.
Stock symbol the letters used to identify corporations at the stock exchanges where their stock is traded (such as XON is Exxon). The letters may be the same as or different from the letters used in newspaper listing.
Stockholder someone who holds one or more shares of stock, or ownership in a corporation.
Strike price see exercise price.
Subrogation a company’s right to recover benefits paid in a lawsuit if the injury was the fault of another. For example, suppose a medical plan pays a participant’s expenses due to injury in a car accident, and later the participant receives a settlement from the driver at fault. The medical plan can recover certain benefits from the participant.
Substance abuse or chemical dependency both alcoholism and drug dependency as classified by the International Classification of Diseases of the U.S. Department of Health and Human Services.
Summary Annual Report (SAR) participants are entitled to this annual report on the financial strength of a qualified benefit plan.
Summary of Material Modifications (SMM) participants are entitled to this summary when a benefit plan makes material changes.
Summary Plan Description (SPD) a document that ERISA requires be made available to participants and beneficiaries (and the DOL upon request). It must summarize the benefit plan in an easy-to-read format and cover key plan provisions.
Supplemental Executive Retirement Plan (SERP) a nonqualified plan that allows employers to offer higher benefits to highly paid employees.
Surgery a branch of medicine that treats injuries, deformities and illness through operative methods.
Takeover change in the controlling interest of a corporation. The takeover may be friendly (often called an acquisition) or unfriendly (often called a hostile takeover).
Tax preparation services services to prepare participants’ tax returns.
Tax sheltered annuity plan (also called a TSA or 403(b) plan) a plan under Section 403(b) of the Internal Revenue Code that allows employees of certain charitable and educational institutions to choose between receiving compensation, and electing to have that compensation contributed on their behalf to a qualified plan.
Tax-deferred an investment that postpones taxation on earnings until the money is withdrawn. Examples include individual retirement accounts, 401(k) plans, and tax sheltered annuities (TSAs).
Taxable wage base the Social Security wage base, or the maximum amount of earnings that are considered wages for that year in calculating Social Security benefits and determining Social Security taxes.
Ten-year certain annuity a form of retirement benefit that provides monthly payments for life, with payments guaranteed for at least 10 years. The payments are reduced by a percentage based on your age when benefits begin. If the annuitant dies before all guaranteed payments are made, the designated beneficiary or estate will receive payments for the rest of the 10-year “certain” period.
Term life insurance insurance for a specific period of time that provides only a death benefit (does not have an investment feature to accumulate cash values the way whole life insurance does). Premiums are generally much lower than for cash value life insurance, and also generally increase each year.
Thrift plan an individual account plan that allows employee contributions on an after-tax basis, and generally features some matching contributions by the employer.
Ticker symbol see stock symbol.
Tobacco use some plans charge different premiums or provide different levels of benefits depending on whether the participant is a tobacco user. See the plan for the definition, including the length of time the participant must be tobacco-free and whether tobacco use includes snuff and chewing tobacco as well as cigarettes, cigars and pipes.
Top-heavy plan a qualified plan that has more than 60% of its benefits allocated to key employees as defined by the plan.
Topical on the surface. In dental plans, this refers to painting the surface of teeth, such as in fluoride treatment, or applying an anesthetic to the gum surface.
Totally disabled disabled as defined by the plan.
Trauma injury; generally, serious and life-threatening injury requiring emergency treatment.
Treasuries negotiable securities of the U.S. government, backed by the full faith and credit of the government. Treasuries provide investment return that is exempt from state and local income taxes but subject to federal income tax.
Treasury bills short-term negotiable securities of the U.S. government issued with terms of a year or less and sold at public auction at a discount in face amounts of at least $10,000. Treasuries are backed by the full faith and credit of the government, and provide investment return that is exempt from state and local income taxes but subject to federal income tax.
Treasury bonds long-term negotiable securities of the U.S. government issued with terms of 10 years or longer and in amounts of at least $1,000. Treasuries are backed by the full faith and credit of the government, and provide investment return that is exempt from state and local income taxes but subject to federal income tax.
Treasury notes negotiable securities of the U.S. government with maturities of from 1 to 10 years. Amounts may range from $1,000 to over $1 million. Treasuries are backed by the full faith and credit of the government, and provide investment return that is exempt from state and local income taxes but subject to federal income tax.
TSA see tax sheltered annuity plan or 403(b) plan.
Ultrasound use of high-frequency sound waves to obtain medical information that cannot be gotten by x-rays. Often used to monitor the development of a fetus.
Uncontested adoption an adoption in which all parties agree.
Uncontested guardianship a guardianship proceeding in which all parties agree.
Universal life insurance a flexible form of life insurance in which the policyholder may change the amount of death benefit (with evidence of insurability for increases), the amount of premium payments, and when premiums are paid.
Unmatched contributions contributions the employee makes that are over an employer’s matched contribution limit.
Urgent a medical condition with symptoms severe enough that postponing care for more than a given number of hours, such as 48, could seriously harm the patient as defined by the plan.
Urgent care treatment for an urgent situation.
Utilization controls or features features designed to control costs and reduce unnecessary care.
Vacation accrual schedule the schedule under which an employee earns vacation time.
Vacation accrual/accrued balance vacation time an employee has earned but not used.
Vacation buy or vacation purchase a plan that allows a participant to buy additional paid vacation time with company consent.
Vacation carryover the maximum amount of accrued vacation a company allows an employee to carry over from year to year.
Vacation exchange plan a plan that allows a participant to buy or sell paid vacation time with company consent.
Vacation sell plan a plan that allows a participant to sell paid vacation time with company consent.
Vaccinations see immunizations.
Variable life insurance a form of life insurance with steady premiums but a death benefit that fluctuates (above a guaranteed minimum) with the value of investments backing the contract.
Variable match or variable matching contributions the variable amount a company may contribute to the employee’s 401(k) account, in addition to the fixed match, based on the employee’s matched contributions.
Variable universal life a form of life insurance with the flexibility of universal life insurance premiums and the investment features of variable life insurance.
Vested benefits that have become fully owned by the participant.
Vesting the employee’s ownership of retirement plan money. The employee is always 100% vested in employee contributions and roll-in contributions plus any investment earnings on those amounts.
Vesting service for retirement plans with company contributions, the percentage of an employee’s benefit that is “vested” (that the employee owns even sif he or she stops working for the company) is determined based on the employee’s vesting service.
Voice response system (VRS) an interactive telephone system that provides benefit information and/or accepts transactions.
Vouchers a dependent care option in which the participant submits periodic vouchers for dependent care to the provider and the employer covers part or all of the cost.
VRS see voice response system
Waiting period see elimination period. Also refers to the days between the filing of a registration for a security with the SEC, and when the security can be legally offered to the public.
Waive to give up a known right on purpose. For example, a participant eligible for certain benefits may have the option to waive those benefits.
Well-baby care medical care such as checkups and immunizations provided for a healthy baby.
Wellness Wellness includes the idea of being healthythat is, without illnessand combines it with the emotional and social aspects of health, to emphasize an overall sense of well-being and holistic health. Consumer driven health plans emphasize wellness to make employees focus on keeping themselves well and thus avoid medical procedures.
Wellness (health promotion) programs a range of programs to promote good health and safety among employees.
Whole life insurance life insurance that provides death benefit coverage but also includes an investment feature and accumulates cash values. Unlike term insurance, for which annual premiums generally increase with age, whole life insurance generally has level premiums for the length of the policy.
Will a document a person drafts to direct the disposition of assets to be made at his or her death.
Withdrawal a distribution from a retirement plan account.
Witness duty time off work to serve as a trial witness.
X-rays radiation of extremely short wavelength that can pass through various solids. X-rays are used to diagnose, photograph, and even treat certain medical conditions. While a patient’s exposure to radiation while an x-ray is being taken is quite low, body parts not being x-rayed may be shielded.
Year of service some plans determine an employee’s eligibility for participation, vesting, or benefit amounts based on the employee’s service. See the plan for the definition of a year of service.
Yield return on an investment.
Zero-coupon bond a bond that is purchased for less than its face amount, that pays no interest until maturity, and that is redeemed at its maturity date for its full face value. For example, a $1,000 five-year zero coupon bond might be purchased for $700 and held for a 5-year maturity, at which time it would be redeemed for the full $1,000. Because a bond’s coupon rate is the rate of interest the bond pays before maturity, this type of bond has a coupon rate of zero.