Glossary
voluntary retirement savings plans that provide income tax advantages to enrollees
the amount you pay, a percentage of the total cost, for specific services
the amount you are required to pay when you receive health care
abbreviation for Consolidated Omnibus Budget Reconciliation Act of 1985. Cobra is a federal law that may allow you to temporarily continue health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay up to 102% of the applicable premiums. AB528 may allow a surviving spouse to extend health coverage when COBRA ends.
the amount you pay out-of-pocket before the plan covers any of the costs of health care
abbreviation for Dental Health Maintenance Organization, a health insurance plan for dental services
evaluation and treatment of an illness, injury, or condition that needs immediate medical attention in an emergency room
abbreviation for Exclusive Provider Organization; plan is similar to a PPO plan except that no out-of-network benefits are provided in California; you must use a participating Anthem Blue Cross network provider within the U.S. to receive benefits
items or services that aren’t covered under your contract for insurance and for which an insurance company won’t pay; for example, elective cosmetic surgery
see Preferred Drug List
abbreviation for Flexible Spending Account; voluntary plans that enable active employees to save money paying for certain health care and dependent care expenses using pre-tax dollars
abbreviation for Health Maintenance Organization. A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency.
a provider who has contracted with a health plan to provide services for a predetermined rate
insurance that pays out according to the policy limit when the policyholder dies. The beneficiary, usually the spouse or child, receives the payment.
a federal health insurance program for people who are age 65 or older and certain younger people with disabilities
a medical plan for retires age 65 or older. Enrollment in Medicare Part A and B may be required in order to enroll in a Medicare Advantage Plan.
prescriptions that are not on the preferred drug list of the health plan
a provider that does not have a contract or is not participating in a contracted network with a health plan. Patients will pay more for services rendered.
the maximum amount you will pay out-of-pocket. Once this limit is reached you may be covered in full by the health plan except for the cost of prescription drugs.
a list of prescription drugs, both brand name and generic that are covered by the health plan. Drugs not on the list may not be covered by the health plan.
a physician who serves as a group member’s primary contact within the health plan and provides basic medical services, and if required by the plan, authorizes referrals to specialists and hospitals
abbreviation for Tax Sheltered Annuity. Voluntary retirement savings plans, such as 403(b)plan, which offer tax advantages to encourage retirement saving.
IRS rules do not allow Plan participants to make election changes except during the Annual Benefits Open Enrollment period. However, the IRS does permit a participant to make a change in the middle of a plan year when certain Major Life Events or Actions take place as outlined in the list below. No exceptions can be made to this policy per IRS rules. Election changes MUST be consistent with the event that prompted the change. You must also submit your changes within 31 days of the event. You MUST appropriately fill out and submit the required documentation, which certifies your event.
Major Life Event:
• Begins/ends full-time employment
• Begins retirement
• Marriage, divorce or death of a spouse
• Birth or adoption
• Death of a covered child
• Spouse gains/or loses employer health plan eligibility
• Spouse loses employment
• Gains/loses eligibility for Medicare
• Employee or dependent moves in or out of plan’s service area
