2026 Open Enrollment Benefits Decision Guide
Glossary
A AD&D Insurance
C COBRA A federal law that may allow you to temporarily continue healthcare coverage after your employment ends, based on certain qualifying events. If you elect COBRA (Consolidated Omnibus Budget Reconciliation Act) coverage, you pay 100% of the premiums, including any share your employer used to pay, plus a small administrative fee. Claim A request for payment that you or your health care provider submits to your healthcare plan after you receive services that may be covered. Coinsurance Your share of the cost of a healthcare visit or service. Coinsurance is expressed as a percentage and always adds up to 100%. For example, if the plan pays 70%, your coinsurance responsibility is 30% of the cost. If your plan has a deductible, you pay 100% of the cost until you meet your deductible amount. Copayment A flat fee you pay for some healthcare services, for example, a doctor’s office visit. You pay the copayment (sometimes called a copay) at the time you receive care. In most cases, copays do not count toward the deductible. D Deductible The amount of healthcare expenses you have to pay for with your own money before your health plan will pay. The deductible does not apply to preventive care and certain other services. Family coverage may have an aggregate or embedded deductible. Aggregate means your family must meet the entire family deductible before any individual expenses are covered. Embedded means the plan begins to make payments for an individual member as soon as they reach their individual deductible. Dental Basic Services Services such as fillings, routine extractions and some oral surgery procedures. Dental Diagnostic & Preventive Generally includes routine cleanings, oral exams, x-rays, and fluoride treatments. Most plans limit preventive exams and cleanings to two times a year.
Dental Major Services Complex or restorative dental work such as crowns, bridges, dentures, inlays and onlays. Dependent Care Flexible Spending Account (FSA) An arrangement through your employer that lets you pay for eligible child and elder care expenses with tax-free dollars. Eligible expenses include day care, before and after-school programs, preschool, and summer day camp for children underage13. Also included is care for a spouse or other dependent who lives with you and is physically incapable of self-care. E Eligible Expense A service or product that is covered by your plan. Your plan will not cover any of the cost if the expense is not eligible. Excluded Service A service that your health plan doesn’t pay for or cover. F Formulary A list of prescription drugs covered by your medical plan or prescription drug plan. Also called a drug list. G Generic Drug A drug that has the same active ingredients as a brand name drug but is sold under a different name. For example, Atorvastatin is the generic name for medicines with the same formula as Lipitor. Grandfathered A medical plan that is exempt from certain provisions of the Affordable Care Act (ACA). H Health Reimbursement Account (HRA) An account funded by an employer that reimburses employees, tax-free, for qualified medical expenses up to a maximum amount per year. Sometimes called Health Reimbursement Arrangements.
An insurance plan that pays a benefit to you or your beneficiary if you suffer from loss of a limb, speech, sight, or hearing, or if you have a fatal accident. Allowed Amount The maximum amount your plan will pay for a covered healthcare service. Ambulatory Surgery Center (ASC) A healthcare facility that specializes in same- day surgical procedures such as cataracts, colonoscopies, upper GI endoscopy, orthopedic surgery, and more. Annual Limit A cap on the benefits your plan will pay in a year. Limits may be placed on particular services such as prescriptions or hospitalizations. Annual limits may be placed on the dollar amount of covered services or on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated health care costs for the rest of the plan year. B Balance Billing In-network providers are not allowed to bill you for more than the plan’s allowable charge, but out-of-network providers are. This is called balance billing. For example, if the provider’s fee is $100 but the plan’s allowable charge is only $70, an out-of-network provider may bill YOU for the $30 difference (the balance). Beneficiary The person (or persons) that you name to be paid a benefit should you die. Beneficiaries are requested for life, AD&D, and retirement plans. You must name your
beneficiary in advance. Brand Name Drug
A drug sold under its trademarked name. For example, Lipitor is the brand name of a common cholesterol medicine.
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