Benefits Definitions

401(k) and 403(b) Retirement Savings Plan – These retirement savings accounts allow you to save money from your paycheck towards a retirement account that is used for when you retire.

Brand Name Drug – When a drug company develops a new drug, they are the ones allowed to make it and sell it for a set time period under their brand name. At some point, other companies are allowed to make generic versions of it, which are often less expensive.

Claim – a claim is what a doctor submits to the insurance company so they can get paid.  It shows the medical services that were provided to you.

Coinsurance – your share of the costs for covered care services, calculated as a percentage.

Company Match – The amount your employer contributes on our behalf to your retirement account.  This can be a set amount or an amount that matches what you put in, normally capped at a certain percent.

Copay – A set dollar amount you pay for a covered service, such as a doctor’s visit.

Covered services – care that you get from doctors and hospitals that your health plan has agreed to pay a portion of, as part of your plan.

Deductible – A set amount of money you pay at first for covered health care services, before your health plan begins paying.

Dependent – Members of the subscriber’s family, like a child or spouse, who are eligibile for benefits under their health plan.

In Network Providers – Doctors and hospitals who have agreed to accept your insurance.  Each plan has its own set of health care professionals.  Getting care from your doctors in your plan is often a good way to get quality care at a more reasonable cost.

Out of Network Providers – A doctor or hospital who has not necessarily agreed to accept your insurance.  Some plans do not cover services from doctors outside your plan.  But even if yours does, you’ll always pay more for the same level of care.

Effective date – the date your health benefits begin.

Explanation of Benefits (EOB) – A statement you get after you go to a doctor or hospital that lists the health care treatment you received.  It shows the amount the doctor charged, how much the health plan paid and what you will be billed based on your benefits.  An EOB is not a bill.

EPO Plan – A type of health insurance plan that covers services only if you stay in network.

Flexible Spending Accounts (FSA) – A special account that allows you to set aside tax-free money to use on qualified health care or dependent care expenses; also known as a health care expense account.

Generic drug – When a drug company develops a new drug, they are the only ones allowed to make it and sell it for a while under their brand name.  At some point, other companies are allowed to start making generic versions of it.  These versions have the same active ingredients and quality standards, but cost less.

Health Reimbursement Arrangement (HRA) – An account of money set up and funded by your employer.  You can use the money to pay your health care costs, until your plan starts paying a bigger share – after you meet your deductible.  It’s a type of consumer-driven health plan (CDHP), sometimes referred to as a member-directed health plan.  At UofL, these are the PCA High and PCA Low plans.

Member – someone enrolled in our health insurance plans, whether they’re the main person on a policy or a qualified dependent.

Premium – The monthly amount you pay out of your paycheck for your health insurance.

Negotiated rates – The amount doctors and hospitals in your plan agree to charge you when you have health insurance.

Open Enrollment – Time of year that employees set aside and you can make changes to your benefits for the next plan year.

Out-of-pocket maximum – The maximum dollar amount you will pay for covered services during the year. After that, your plan will pay the rest of your covered care that year.

PPO Plan (Preferred provider organization) – A type of health insurance plan that covers services from almost any doctor or hospital.  But you’ll almost always pay less for the same level of care when you go to one in your health plan.  You don’t usually need a referral from your main doctor, also called a primary care physician or primary care doctor, to see a specialist.

PrimaryCare Physician (PCP) – Your main or family doctor.  You see them for checkups and preventative care.  They look out for your whole health, and they are also your first stop if you are sick or injured (unless it is an emergency).  With some health plans, especially HMO plans, you may need to go through your PCP to get a referral to other doctors – like specialists.

Qualifying Adult (QA) - A Qualified Adult is an individual in a domestic partnership with an Employee or Former Employee. For this purpose, an individual will be considered to be in a “domestic partnership” with an Employee or Former Employee if the following conditions are satisfied: Such individual is the Employee’s/Former Employee’s sole domestic partner and intend to remain so indefinitely; Such individual and the Employee/Former Employee maintain a common residence and intend to continue to maintain such common residence, or do not currently maintain a common residence due to an international employment assignment or other employment-related, financial, or similar obstacle; Such individual is at least 18 years of age and mentally competent to consent to a contract; Such individual and the Employee/Former Employee share responsibility for a significant measure of each other’s financial obligations; Such individual and the Employee/Former Employee are not married or joined in a civil union to anyone else; Such individual and the Employee/Former Employee are not a domestic partner of anyone else; Such individual and the Employee/Former Employee are not related in a way that would prohibit legal marriage in the U.S. jurisdiction in which the partnership was formed; Such individual and the Employee/Former Employee provide documentation demonstrating fulfillment of these requirements, and certify that they understand that willful falsification of the documentation required to establish that an individual is in a domestic partnership may lead to disciplinary action and the recovery of the cost of benefits received related to such falsification. Notwithstanding the foregoing, an individual shall not be treated as a Qualified Adult for purposes of a Component Program unless any and all documentation of the relationship required by the Administrator or Insurer is filed with the Administrator by the Employee or Former Employee, as applicable.

Qualifying Event – An event that allows you to make certain changes during the year to your benefit elections.  You have 30 days from the date of the qualifying event to make changes.

Specialist – A doctor or other health professional who has advanced education and training in a certain area of medicine.

Vesting – The amount of time you have to work for an employer to earn full benefits from the employer contribution to your retirement account.  Example, you have to work for the employer for three years before you are 100% vested and you receive 100% of the employer contributions.