Common Benefit Terms/Glossary
Frequently Asked Questions
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1. Annual Benefit Salary (ABS)
Calculated as one times your annual wages, rounded up to the nearest $1,000. Drivers that are not paid an hourly rate will have an ABS of prior year's wages, rounded up to the nearest $1,000. Newly hired/re-hired drivers will have a beginning ABS of $42,000 for the reminder of the calendar year; the ABS will be adjusted their first January to reflect prior year's wages or $42,000, whichever is greater.
Your share of the costs of a covered health care service, calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan's allowed amount for an office visit is $100 and you've met your deductible, your co-insurance payment of 20 percent would be $20.
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered service.
The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
Money that a member contributes to a 401(k) plan through payroll deduction.
6. Explanation of Benefits (EOB)
Provided by the insurance company, this document details the way in which benefits were paid on a particular claim.
7. Family and Medical Leave Act (FMLA)
If eligible under this federal law, a team member may receive up to 12 weeks of job protected leave.
8. Flexible Spending Account (FSA)
A reimbursement account to which employees contribute pre-tax dollars for payment of health and/or dependent care expenses. Employers may also choose to contribute to employees' health care FSA accounts.
9. High Deductible Health Plan (HDHP)
A medical insurance plan with a high annual deductible. A HDHP will not provide benefits until a minimum deductible is met, with the exception of preventative care. There are statutory minimum deductibles and out-of-pocket maximums that are subject to annual cost of living adjustments.
10. Health Savings Account (HSA)
A tax-favored health care savings account, managed by the individual, which accumulates and carries over from year-to-year. Qualified expenses may be paid tax-free from the account. Eligibility requirements apply.
11. Health Insurance Portability and Accountability Act (HIPAA)
This federal law improves the access to health insurance when changing jobs by restricting certain pre-existing condition limitations, protecting the health privacy of the individual and the standardization of medical records.
12. Long-term Disability (LTD)
Disability benefits that may begin after short-term disability benefits have been exhausted.
13. Maintenance of Benefits (MOB)
Applies when a member or dependent is covered by more than one insurance policy. It is a method of limiting insurance payments to no more than 100 percent of the approved charges.
14. Medicare Secondary Payer (MSP)
If a member or dependent had coverage through both Medicare and a group health plan, in most cases, the group health plan will pay primary and Medicare secondary on a covered service.
15. Open Enrollment
The opportunity each year to choose the benefits and coverages desired for the upcoming benefits plan year. Also referred to as Annual Benefits Enrollment.
16. Out-of-Pocket Maximum
The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100 percent of the allowed amount. This limit never includes your premium, balance-billed charges or health care your health insurance or plan doesn't cover. Some health insurance or plans don't count all of your co-payments, deductibles, co-insurance payments, out-of-network payments or other expenses toward this limit.
17. Preferred Provider Organization (PPO)
A PPO is a group of health care providers who have an agreement to provide quality health care at discounted rates.
18. Summary Plan Description (SPD)
A booklet or certificate describing each benefit in greater detail including: eligibility, covered services, payment schedules, limitations or exclusions, etc.
19. Specialty Drugs
High-cost injectables, infused, oral or inhaled drugs for the ongoing treatment of a chronic condition. These drugs generally require special handling and storage with close supervision and monitoring of the patient's drug therapy.
20. Short-term Disability (STD)
A benefit providing income to a member while off work due to a non-work-related illness or injury.
21. Usual, Customary and Reasonable (UCR)
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.
A process of identifying potential risk for either approval or denial of coverage.
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