• Employee Insurance

  • Glossary of Insurance Terms 

    • Illustrated glossary You might want to start here with health coverage terms, provided by PreferredOne.  
      It includes visual examples of how you and your insurer share costs.
    • Benefits 101 Guide from CHS  
    • FAQ FLYER from CHS: Answers to the Most Frequently Asked Benefit Questions

    AD&D/personal accident insurance

    An Accidental Death & Dismemberment policy pays benefits to the beneficiary if the cause of death is due to an accident. It pays a fractional amount for loss of limb or sight. Group AD&D insurance is included with your group life insurance. You may also purchase additional voluntary AD&D insurance.

     

     

    beneficiary

    The beneficiary of a life insurance policy is the person who receives the payment of the amount of insurance after the death of the insured.

     

     

    carrier

    The health insurance company is referred to as a "carrier." Your doctor would be referred to as a "provider."

     

     

    certificate of coverage

    A description of the healthcare coverage included in an insurance company's plan (sometimes called "benefits book"). These are not typically mailed out anymore, but are available in PDF format on your carrier's website or by request from the insurance carrier.

     

     

    COBRA

    A federally regulated law that gives employees and their eligible dependents the opportunity to remain in their employer's group coverage when they would otherwise lose coverage because of certain qualifying events. Often referred to as "continuation of benefits."

     

     

    coinsurance

    The share of the service costs that you are responsible for paying. It is listed as a percentage. If you have 80% coverage, that means you pay 20% of the total cost.

     

     

    contribution

    The district and the employee each pay a contribution toward the premium (varies according to contract)

     

     

    copay(ment)

    The amount you will pay for services or prescriptions. It is usually a flat amount such a $40 for each office visit ("$40 copay").  This payment is expected up front, then your office visit is billed to insurance, and your insurance pays the difference or applies the difference toward your deductible.

     

     

    daycare flex

    A common nickname for a Flexible Spending Account (FSA) that reimburses for dependent care (usually children aged 12 & under)

     

     

    deductible

    The amount you pay before the insurance company starts paying. It is usually listed as an "annual" amount.

     

     

    deduction

    The amount taken out of each paycheck to contribute toward a premium

     

     

    embedded deductible

    There is a family deductible, but there is also a smaller, individual deductible. If there is one person who meets the smaller deductible but the family deductible is not yet met, and that person is still incurring medical bills, the plan will start to pay benefits for that person. The PreferredOne deductibles are embedded. The PEIP Advantage and Value plans have embedded deductibles as well, but the PEIP HSA-Compatible plan has non-embedded deductibles to comply with IRS regulations regarding HSAs.

     

     

    Evidence of Insurability

    If you do not elect supplemental life insurance during your initial enrollment, or if you want to add coverage above the guarantee issue amount, you need to fill out a form for CIGNA (available from CHS when you enroll) answering some medical questions. CIGNA might require a physical exam, or other evidence of insurability.

     

     

    family

    Coverage for employee plus two or more other people (may be legal spouse and/or dependents)

     

     

    flex

    A common nickname for Flexible Spending Account (FSA)

     

     

    formulary

    A list of prescription drugs covered by a particular drug benefit plan

     

     

    FSA

    Flexible Spending Account (employee elects to put pretax money in with each paycheck)

     

     

    Guaranteed issue

    Guaranteed issue is the amount of supplemental life insurance coverage you may purchase without having to provide Evidence of Insurability

     

     

    HIPAA

    Health Insurance Portability and Accountability Act of 1996. A federal law that includes important new protections for millions of working Americans and their families who have preexisting medical conditions, or might suffer discrimination in health coverage based on a factor that relates to an individual's health. HIPAA requires health plans to maintain the privacy of any personal information relating to its members' physical or mental health.

     

     

    HRA

    Health Reimbursement Arrangement (employer puts pretax money in with each paycheck if this is in your contact/guidebook). This is what is used with the HSA-compatible plan for teachers, as well; we do not offer an HSA.

     

     

    HSA

    Health Savings Account (not offered by ISD 273). PEIP refers to an HSA-compatible plan; that can be used with an HRA, instead.

     

     

    in-network

    An in-network provider is one contracted with the health insurance company to provide services to plan members for specific pre-negotiated rates.

     

     

    LTD

    Long-term disability (income protection) policies provide financial support in the event of the policyholder becoming unable to work because of disabling illness or injury.

     

     

    medical flex

    A common nickname for a Flexible Spending Account (FSA) that reimburses for healthcare, dental care, orthodontics, or corrective lenses.

     

     

    non-embedded deductible

    The entire family has one deductible that must be met before the full insurance benefits begin. This deductible can be met by a single person in the family or by several family members. There is not a smaller deductible for individuals within the family deductible. The PEIP HSA-compatible plan has deductibles that are non-embedded.

     

     

    out-of-network

    An out-of-network provider is one not contracted with the health insurance plan. The insurance company will either pay less or not pay anything for services you receive from out-of-network providers.

     

     

    out-of-pocket maximum

    The most you will pay for your health care during the plan year (with the exception of your portion of premiums).

     

     

    personal accident insurance

    ING, our life insurance provider in 2013, calls voluntary AD&D "personal accidental insurance." See AD&D for definition.

     

     

    premium

    Total monthly amount owed to the insurance company. This includes both the employer AND employee contributions. When we say that the premium has gone up by a certain percent, we are referring to the overall cost, not just the employee portion.

     

     

    provider

    A provider of medical or health services.

     

     

    qualifying status change

    HIPAA qualifying status changes include:

    • Marriage
    • Divorce
    • Birth or adoption of a child
    • Death of a spouse or child
    • Change in your spouse's employer's medical coverage
    • Child's loss of eligibility due to age or marital status
    • Commencement of or return from an unpaid leave of absence by you or your spouse
    • A residence change effecting eligibility for you, your spouse or a dependent
    • You, your spouse or dependent becomes eligible for Medicare or Medicaid
    • A judgment, decree or court order that requires a coverage change
    If you have one of the above changes, you can make changes to your insurance outside of the open enrollment period.  Only benefit changes which are consistent with the change in family status are permitted. You must notify Corporate Health Systems of your change in family status and complete a new enrollment form within 30 days after the qualifying event.
     
    Most of these and  a few other qualifying life events also qualify you for a special enrollment period in MNsure, if you choose to go with the state health insurance exchange rather than district insurance.
     

     

    single

    Coverage for employee only (marital status need not be single)

     

     

    single+1

    Coverage for employee plus one other person (may be legal spouse or dependent)

     

     

    supplemental

    Supplemental life insurance may be elected by the employee and paid for through payroll deductions.

     

     

    VEBA

    VEBA is an acronym for Voluntary Employee Benefit Account. Your HRA and FSA are VEBAs.

     

     

    voluntary

    Voluntary AD&D insurance may be elected by the employee and paid for through payroll deductions.