Terms to Know |
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| Balance Billing When you go to an out-of-network provider for medical and dental services, you may be responsible for the difference between the full cost (amount billed) and Reasonable and Customary charge (maximum amount paid) in addition to any coinsurance amounts. |
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| Basic Dental Services Routine dental procedures such as root canals and cavity fillings. |
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| Cafeteria Plan An employee benefit arrangement allowed by IRS Code Section 125, under which employees are allowed to pay for certain employee benefits on a pre-tax rather than an after-tax basis. |
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| Coinsurance A percentage of the cost of eligible medical expenses you are responsible for paying, after the deductible is met. |
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| Copayment A fixed dollar or percentage you pay each time you receive certain medical services – (i.e. office visits, prescription drugs). |
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Defined Benefit Pension Plan
*Covered compensation is the 35-year average, ending at age 65 of the taxable Social Security Wage bases. Covered compensation tables are published by the Internal Revenue Service. |
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Defined Benefits Pension Restoration Plan
For example, the Code limits annual compensation used to determine benefits under the qualified retirement plans to $360,000 in 2011 ($245,000 if hired after 1995). Similar annual limits on compensation apply to prior years. Also, the Code limits annual benefits payable from the qualified plans to $195,000 in 2011 for those commencing payments at normal retirement age. So, the Pension Restoration Plan restores pension benefits attributable to compensation or benefits payable in excess of the Code limits. |
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Defined Contribution / 401(k)
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| Deductible The amount of money you pay each plan year before the medical and/or dental plan pay a benefit. |
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Elements of Compensation
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| Evidence of Insurability Any statement of proof of a person’s physical condition affecting his/her acceptance for insurance. |
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| Employer-Paid Benefits A cost incurred by your employer for your health and welfare coverage, income protection, retirement benefit, social security / Medicare and taxes. |
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| Eligible Charges Charges for services that are covered under a benefit plan. |
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| Flexible Spending Account (FSA) – Dependent Care Allows employees to use pre-tax dollars from their paychecks to pay for the cost of care for children or elderly dependents. |
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| Flexible Spending Account (FSA) – Health Care Allows employees to use pre-tax dollarsfrom their paychecks to pay for eligiblemedical expenses. |
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| Flexible Spending Account (FSA) – Limited Purpose Allows employees to use pre-taxdollars from their paychecks to pay for thecost of eligible dental and vision expenses.You are only allowed to participate in thisplan if you are enrolled in a High DeductibleHealth Plan (Consumer Choice PPO Plan). |
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| Generic Drugs Generic drugs have the same chemical make-up of a corresponding non-preferred brand drug whose patent has expired. |
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| Health Coverage Includes medical, dental, and vision. |
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Health Maintenance Organization (HMO) |
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| Health Savings Account (HSA) A Health Savings Account is the vehicle that allows employees in a high deductible health plan (HDHP) to set aside tax-exempt contributions for current and future qualified medical expenses in an account made available through your employer or financial institution. |
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| High Deductible Health Plan (HDHP) An HDHP allows you to save money on your insurance premium in exchange for a higher deductible. When you are covered under a traditional medical plan, you pay a substantial monthly premium, whether you use the plan or not. |
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| Income Protection Includes long-term disability insurance. Some employers also offer short-term disability and sick pay. |
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| Major Dental Services Extensive dental procedures such as crowns, bridges and dentures. |
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| Non-Preferred Brand Drugs A medication that has been patented for name and chemical content. Once the patent expires, generic drugs with a different name but the same chemical make-up usually become available. Non-preferred brand drugs are all other prescription drugs that are not generic or on the list of Preferred drugs. The highest copay is charged for these drugs because they are either the most expensive and/or have a comparable drug that is either generic or on the preferred list. |
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Nonqualified Deferred Compensation (NQDC)
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| Preferred Provider Organization (PPO) An organization in which networks arecreated with Preferred Providers (Medical/Dental professionals who have contractswith the organization to provide servicesat a discounted rate). Generally benefitswill be greater and costs will be lower if theparticipant uses an in-network provider. |
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| Pre-Existing Condition A medical condition that could exclude you from receiving benefits associated with that condition for a defined period of time. |
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| Preferred Drugs These are prescription drugs that have been placed on a list of preferred drugs for a medical plan with a prescription copay. The copay for preferred drugs is generally less than non-preferred brand drugs but higher than a generic drug copay. |
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| Pre-Tax / Tax Advantage Reimbursement Accounts Consists of Flexible Spending Health Care Account, Flexible Spending Dependent Care Account, Flexible Spending Limited Purpose Account and Healthcare Savings Account. These accounts allow you to contribute money on a pre-tax basis for a specific purpose. This allows you to lower your taxable income by using tax-free money for allowable expenses. For a list of allowable expenses reference the IRS website, www.irs.gov, publication 502. |
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| Preventive Dental Services Routine services such as cleanings and checkups. |
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| Qualified Status Change An event that allows you to make coverage changes you could not otherwise make under a pre-tax plan as long as you make those changes within 31 days of the event – (i.e. marriage, divorce, etc.) Note: birth of child is 60 days of the event. |
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| Reasonable & Customary (R&C) The average fee charged by a particular type of provider within a geographic area. Medical and Dental plans use this amount to determine the maximum amount they will pay for a service. |
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| Routine Care Includes doctor visits, exams and other services for the purpose of monitoring a diagnosed condition. |
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| Social Security / Medicare An estimate of the employee cost for Social Security/Medicare is calculated by multiplying your base pay up to $106,800 times 5.65% plus any eligible earnings above $106,800 times 1.45%. The estimate of the Employer cost for Social Security/Medicare is calculated by multiplying your base pay up to $106,800 times 7.65% plus any eligible earnings above $106,800 times 1.45%. If you would like to know more about Social Security benefits go to the Social Security Administration’s website at www.socialsecurity.gov. |
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| Total Rewards The total value of your benefits and pay, including total compensation, and employer-paid benefits (health and welfare & retirement benefits). |
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| Welfare Coverage Includes life / Accidental Death & Dismemberment (AD&D) insurance. |
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Wellness Benefits |
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