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A

ACA (Affordable Care Act)

Federal law that mandates health coverage standards and requires large employers to offer insurance.

Accident Insurance

A policy that pays a cash benefit directly to the employee following a specific physical...

Accrued Benefit

The amount of retirement benefits a participant has earned to date based on plan rules.

Accumulator Adjustment

A policy where manufacturer coupons do not count toward an employee's deductible.

Active Employee

An individual currently on the company payroll and eligible for benefits.

Active Enrollment

An enrollment where employees must choose a plan or they will have no coverage.

Active Management

An investment strategy where a manager actively chooses stocks to beat market returns.

Activity Tracker

A device that monitors physical activity levels often integrated into wellness plans.

Actuarial Value

The percentage of total average costs for covered benefits that a plan will pay.

Ad-Hoc Report

A customized one-time report created for a specific need or data request.

AD&D Insurance

Pays a benefit if you die or lose a limb or eyesight due to an...

Adherence

The degree to which a patient takes their medication exactly as prescribed.

Affinity Group

A voluntary employee-led group based on shared characteristics or life experiences.

Affordability Test

The ACA requirement that a health plan's premium not exceed a certain percentage of employee...

After-Tax Deduction

Money taken out of a paycheck after taxes are calculated (e.g. Roth 401k).

Age-Banded Rates

Insurance premiums that increase as the employee gets older.

AI-Powered Navigation

Using artificial intelligence to guide employees to the highest quality lowest cost healthcare providers.

ALE (Applicable Large Employer)

An employer with 50+ full-time employees required by the ACA to offer health insurance.

Allowed Amount

The maximum amount on which payment is based for covered health care services.

Alternative Funding

Financing models like self-insurance used to pay for healthcare.

Anniversary Date

The date on which a plan renews or an employee's eligibility increases.

Annuity

A financial product that pays out a fixed stream of payments to an individual primarily...

Anti-Bias Training

Education designed to help employees recognize and mitigate unconscious prejudices.

API (Integration)

Tech that allows an HR system to sync data directly with insurance carriers.

Approvable Event

A life change that is legally allowed to trigger a special enrollment period.

Arrears

Unpaid benefit premiums that are owed by an employee from a previous pay period.

Asset Allocation

The strategy of dividing your investment portfolio among stocks bonds and cash.

Auto-Enrollment

A feature that automatically signs employees up for the retirement plan unless they opt out.

Auto-Escalation

A feature that automatically increases an employee’s 401k contribution percentage annually.

Average Wholesale Price (AWP)

The benchmark price used by PBMs to calculate drug reimbursements and discounts.

B

BAA (Business Associate Agreement)

A contract required by HIPAA to ensure vendors protect employee health data.

Backup Care

Short-term care solutions for children or elderly adults when primary care arrangements fall through.

Balance Billing

When a provider bills you for the difference between the provider’s charge and the allowed...

Basic Life Insurance

A set amount of life insurance provided by the employer at little or no cost...

Basic Vision

Coverage for routine eye exams and a limited allowance for glasses or contact lenses.

Behavioral Health

A broad term covering mental health services and substance use treatments.

Beneficiary

The person designated to receive retirement funds if the employee passes away.

Beneficiary Designation

The legal process of naming who receives benefits upon an employee's death.

Benefit Analytics

The use of data to evaluate the performance cost and engagement of benefit programs.

Benefit Census

A master list of employee data used by brokers to get insurance quotes.

Benefit Class

A grouping of employees (e.g. Executive or "Hourly") with different benefit levels.

Bereavement Leave

Paid or unpaid time off provided to employees following the death of a family member.

Bi-Weekly Payroll

A pay schedule where employees are paid every two weeks (26 times a year).

Bioequivalent

A generic drug that reaches the bloodstream at the same rate as the brand-name version.

Bond

A debt security where an investor lends money to an entity for a fixed interest...

Brand-Name Drug

A medication sold by the original manufacturer under a trademarked name.

Broker of Record (BOR)

A legal document designating a specific broker to represent the employer.

Brokerage Window

An option in a 401k plan allowing employees to buy stocks outside the standard fund...

Bundled Payments

A "flat-rate" price for a specific medical procedure (like a knee replacement) that includes the...

Burnout Prevention

Organizational strategies to reduce employee exhaustion and stress.

Buy-Up Plan

An option for an employee to pay more to receive a higher level of coverage...

C

Cafeteria Plan

A plan allowing employees to choose between taxable cash and certain qualified benefits.

Captive Insurance

A form of self-insurance where a company creates its own 'mini' insurance company to provide...

Care Management

Programs that coordinate care for employees with chronic conditions to improve outcomes.

Care Navigation

Assistance for employees in finding the best quality care at the lowest cost.

Caregiver Stipend

Financial support provided to employees to help cover the costs of caring for family members.

Carrier Feed

An automated data file sent from an HR system to an insurance company.

Carve Out

When an employer separates a specific benefit (usually Prescription Drugs or Mental Health) from the...

Carve-Out (Pharmacy)

When an employer separates the pharmacy benefit from the medical plan to use a specialized...

Case Management

A process where a health professional coordinates care for an individual with complex medical needs.

Catch-Up Contribution

Extra contributions allowed for employees age 50+ to boost their retirement savings.

Census File

A spreadsheet containing detailed employee demographics used for plan renewals.

Center of Excellence (COE)

A medical facility recognized for superior outcomes in a specific specialty.

CHIP Notice

An annual notice informing employees of potential state premium assistance for children.

Claim Transparency

The ability for employers to see the actual cost and data behind medical claims.

Claims Informatics

Deep data analysis of medical claims to identify trends gaps in care and savings opportunities.

Cliff Vesting

A schedule where an employee becomes 100% vested only after a specific period of time.

Clinical Efficacy

The power of a drug to produce a desired medical effect under ideal conditions.

COBRA

Federal law that lets you keep your group health insurance for a limited time after...

Coinsurance

Your share of the costs of a covered health care service calculated as a percent.

Comorbidity

The presence of two or more chronic conditions (e.g. depression and heart disease) in one...

Composite Rates

A flat insurance rate charged regardless of the employee's age.

Compound Drug

A custom-mixed medication created by a pharmacist for a specific patient's needs.

Compound Interest

Interest calculated on both the initial principal and the accumulated interest from prior periods.

Compressed Workweek

A schedule such as a 4/10 or 9/80 that allows employees to work full-time hours...

Constructive Receipt

The tax principle where income is taxable when it is made available to the employee.

Contingent Worker

A non-permanent worker such as a freelancer or independent contractor.

Coordination of Benefits (COB)

A process to determine which plan pays first when a person is covered by more...

Copay

A fixed amount you pay for a covered health care service at the time of...

Cost Center

A code used in payroll to track which department is paying for an employee's benefits.

Cost Transparency Tools

Apps or websites that allow employees to compare prices for medical procedures.

Counseling

Professional guidance for individuals to help resolve personal or psychological problems.

Creditable Coverage

Health coverage that is at least as good as the standard Medicare prescription drug plan.

Crisis Intervention

Immediate short-term support for individuals in a mental health emergency.

Critical Illness

A policy that pays a lump sum if you are diagnosed with a specific major...

Critical Illness Insurance

Provides a lump-sum cash payment if you are diagnosed with a major illness like a...

D

Day Treatment

Intensive mental health care where patients return home each evening.

Decision Support

Interactive tools that help employees choose the most cost-effective health plan during enrollment.

Deductible

The amount you owe for health care services before your insurance begins to pay.

Deduction Code

A label in the payroll system that determines the tax status of a benefit payment.

Defined Benefit Plan

A traditional pension that promises a specific monthly benefit at retirement based on salary and...

Defined Contribution Plan

A plan like a 401(k) where the retirement benefit depends on contributions and investment performance.

DEIB

Diversity Equity Inclusion and Belonging; the four pillars of a modern workplace culture.

Dental HMO (DHMO)

A dental plan that requires you to use a specific network dentist to receive coverage.

Dental PPO (DPPO)

A dental plan that allows you to visit any dentist but offers discounts for in-network...

Dependent Audit

A process to verify that everyone enrolled as a dependent is legally eligible for coverage.

Diagnostic Service

Tests or procedures (like X-rays or labs) performed to find the cause of a symptom.

Digital Pharmacy

An online-first pharmacy model that offers home delivery and transparent pricing.

Direct Contracting

Negotiating prices directly with hospitals cutting out the insurance carrier.

Direct Deposit

The electronic transfer of a net paycheck directly into a bank account.

Direct Primary Care [DPC]

A healthcare model where patients pay a monthly fee directly to their primary care physician...

Direct Rollover

Moving retirement funds directly from one plan to another to avoid taxes or penalties.

Discretionary Match

An employer contribution to a 401k that the company decides on a year-by-year basis.

Dispensing Fee

The amount paid to a pharmacy for the professional service of filling a prescription.

Dividend

A portion of a company's profit paid out to its shareholders.

Dollar-Cost Averaging

Investing a fixed amount at regular intervals regardless of market price.

Domestic Tourism

Traveling within the country to a COE for a specific surgery or treatment.

Drug Tiers

The groups (Tier 1 2 3 etc.) that determine an employee's copay based on the...

Dual Coverage

When an individual is covered by two health insurance plans simultaneously.

Durable Medical Equipment (DME)

Medical equipment such as wheelchairs or oxygen tanks that can withstand repeated use.

E

EAP (Employee Assistance Program)

Confidential counseling and referrals provided by the employer for personal or work issues.

EDI (Electronic Data Interchange)

The standard format for transferring benefit enrollment data between employers and carriers.

EEOC

The Equal Employment Opportunity Commission which enforces federal laws against workplace discrimination.

Effective Date

The exact date an employee’s insurance coverage or benefit plan begins.

Elective Deferral

The portion of pay an employee chooses to contribute to a retirement plan pre-tax.

Eligibility Rule

The criteria (like hours worked) an employee must meet to join a benefit plan.

Elimination Period

The waiting period between the start of a disability and when benefit payments begin.

Emergency Room Care

Services for a medical condition that requires immediate attention to prevent serious jeopardy.

Employee Self-Service (ESS)

A portal where employees can manage their own personal data and benefits.

Employer Contribution

The portion of a benefit premium or retirement match paid for by the company.

Employer-Sponsored Clinic

A health clinic located on or near a company's worksite for employee use.

Enrollment Window

The specific timeframe during which an employee can sign up for benefits.

EPO (Exclusive Provider Organization)

A managed care plan where services are covered only if you use doctors in the...

ERISA

Federal law that sets minimum standards for voluntarily established pension and health plans.

Evidence of Insurability (EOI)

A health questionnaire required by insurers for high-value life insurance.

Exclusion (Pharmacy)

A specific drug or class of drugs that is not covered by the health plan.

Exempt Employee

An employee not entitled to overtime pay under the Fair Labor Standards Act.

Expense Ratio

The annual fee charged by an investment fund to cover its operating expenses.

Explanation of Benefits (EOB)

A statement from your insurer explaining what medical treatments were paid for and what you...

Extended Care

Medical and social services for those with chronic illnesses or disabilities over a long period.

F

Fair Market Price

The average price for a medical service based on regional data rather than high list...

Family-Building Benefits

Support for paths to parenthood including IVF egg freezing adoption and surrogacy.

Fertility Benefits

Coverage for treatments such as IVF egg freezing or specialized consultations.

FICA

Federal Insurance Contributions Act; the tax for Social Security and Medicare.

Fiduciary

A person or entity legally required to act in the best interest of plan participants.

Fiduciary PBM

A PBM that is legally required to act in the employer’s best financial interest.

Financial Wellness

Programs that help employees manage debt budget and save for future goals.

Form 1095-C

The tax form used to report information about health insurance coverage offered by large employers.

Formulary

The list of preferred prescription drugs covered by a specific health insurance plan.

Fringe Benefits

Extra perks (like company cars) provided to employees beyond their base salary.

Full-Time Equivalent (FTE)

A unit of measurement used to determine if an employer is subject to ACA mandates.

FUTA

Federal Unemployment Tax Act; an employer-paid tax for unemployment.

G

Garnishments

A legal process where a portion of a paycheck is withheld to pay a debt.

Gender-Affirming Care

Health care services that support and affirm an individual's gender identity.

Generic Drug

A low-cost version of a brand-name drug with the same active ingredients.

GLP-1 Management

Clinical programs designed to manage the use and cost of weight-loss medications like Wegovy.

GPO (Group Purchasing Org)

An entity that pools purchasing power to get better rates on medical supplies or drugs.

Grandfathered Plan

A health plan that existed before the ACA and is exempt from certain newer requirements.

Grievance

A formal complaint filed by a participant regarding their health plan's operation or care.

Gross Pay

The total amount an employee earns before any taxes or deductions are taken out.

Group Number

The unique ID assigned by an insurance company to an employer’s specific plan.

H

Habilitation Services

Health care services that help a person keep learn or improve skills for daily living.

Hardship Withdrawal

An emergency withdrawal from a retirement account for an immediate and heavy financial need.

Health Risk Assessment (HRA)

A survey used to identify potential health risks in a workforce.

Health Scorecard

A report that measures the overall health and risk levels of an entire employee population.

HIPAA

Federal law protecting the privacy and security of an individual's personal health information.

HMO (Health Maintenance Organization)

A plan that usually limits coverage to care from doctors who work for or contract...

Holistic Well-being

A benefits strategy that addresses physical mental financial and social health together.

Hospice Services

Specialized care focused on the palliation of a terminally ill patient's symptoms.

Hospital Indemnity

A plan that pays a fixed cash amount for every day you are confined to...

Hourly Employee

An employee paid a set rate for every hour worked.

HRIS

Human Resources Information System; software used to manage employee data.

I

Identity Theft

A service that monitors your credit and helps restore your identity if it is stolen.

Identity Theft Protection

A service that monitors personal data and helps restore identity if it is stolen.

Imputed Income

The value of a non-cash benefit that is considered taxable income by the IRS.

In-Network

Providers and facilities that have a contract with your insurer to provide services at a...

Inclusive Benefits

Benefit designs that ensure equal access for LGBTQ+ neurodivergent and diverse family structures.

Independent TPA

A claims administrator that is not owned by a major health insurance company.

Index Fund

A mutual fund designed to match or track the components of a specific market index.

Inpatient Care

Health care that you get when you are admitted as a patient to a hospital.

Interoperability

The ability of different HR and insurance computer systems to exchange and use data seamlessly.

IRA (Individual Retirement Account)

A tax-advantaged account used by individuals to save for retirement.

L

Leave of Absence (LOA)

A period of time an employee is away from work for medical or personal reasons.

Leaves of Absence (LOA)

Time away from work for reasons like maternity medical or military leave.

Legal Insurance

A plan providing access to attorneys for common personal legal matters like wills or traffic...

Legal Plan

Pre-paid access to attorneys for common personal legal issues like wills or house closings.

Level-Funded Plan

A type of health insurance plan that combines aspects of self-funding and traditional fully insured...

Level-Funding

A hybrid plan where employers pay a fixed monthly fee that covers all insurance costs.

Life Event

A change (like marriage) that allows for mid-year benefit changes; see also QLE.

Lifestyle Spending Account (LSA)

An employer-funded account for health and lifestyle expenses.

Long-Term Disability (LTD)

Provides income replacement for severe long-term disabilities that prevent working.

Look-Back Measurement

A method to determine full-time status for ACA compliance over a set period.

Look-Back Period

A timeframe used to determine if an employee counts as full-time for ACA purposes.

Low-Value Care

Medical services that provide little to no benefit to the patient given their cost.

M

MAC (Maximum Allowable Cost)

The upper limit a plan will pay for generic or multi-source brand drugs.

Maintenance Drug

Medication taken on a long-term basis for chronic conditions like diabetes.

Mandated Benefits

Benefits that are required by federal or state law to be included in an insurance...

Manual Check

A physical paycheck written outside of the normal automated payroll cycle.

Matching Contribution

Money an employer adds to an employee's 401k based on the employee's own contribution level.

Maximum Contribution

The highest amount allowed by the IRS to be put into a 401k or HSA.

Maximum Out-of-Pocket

The total limit an employee will pay for covered services in a plan year.

Medical Loss Ratio [MLR]

 A requirement that insurance companies spend at least 80-85% of premium dollars on medical care/quality...

Medically Necessary

Health care services or supplies needed to prevent diagnose or treat an illness or injury.

Mental Health Parity

A law requiring mental health benefits to be equal to medical/surgical benefits.

Micro-Learning Stipend

Small funds provided for short specific skill-building courses or certifications.

Mindfulness App

Digital tools provided to employees to help with meditation and stress reduction.

Minimum Essential Coverage (MEC)

The basic level of health insurance required to satisfy the ACA's individual mandate.

Minimum Value (MV)

A health plan that covers at least 60% of total allowed costs for standard benefits.

Multi-Source Drug

A medication that has at least one generic equivalent available on the market.

Mutual Fund

An investment vehicle made up of a pool of money from many investors to buy...

N

NAR (Net After Rebate)

The actual cost of a drug to the employer after all PBM rebates are subtracted.

Narrow Network

A smaller curated group of providers that offers lower costs for higher quality.

Near-Site Clinic

A health center located close to a company for employees and their families.

Negotiated Rate

The discounted price an insurance company has agreed to pay a provider for a service.

Net Cost

The final cost of healthcare after all discounts rebates and fees are applied.

Net Pay

Take-home pay after all taxes and benefit deductions have been removed.

Network Pharmacy

A pharmacy that has a contract to provide drugs to plan members at a discount.

Neurodiversity

The concept that neurological differences (like ADHD or Autism) are natural variations of the human...

New Hire Onboarding

The process of integrating a new employee and enrolling them in benefits.

Non-Exempt Employee

An employee who must be paid overtime for hours worked over 40 per week.

Non-Participating Provider

A healthcare provider who does not have a contract with your insurance company.

Non-Preferred Drug

A drug not on the formulary list usually requiring a much higher copay.

Nondiscrimination Testing

Annual IRS tests to ensure benefit plans do not favor highly compensated employees.

O

Off-Cycle Payroll

A pay run performed outside of the normal scheduled dates.

On-Demand Pay

A benefit allowing employees to access their earned wages before the scheduled payday.

Open Enrollment

The annual window when employees can review and change their benefit selections.

Open Enrollment Period

The annual window to sign up for or change workplace benefits.

Organic Engagement

When employees participate in benefits because they find value not just for rewards.

Out-of-Network

Providers who do not have a contract with your health insurance plan.

Out-of-Pocket Maximum

The most you have to pay for covered services in a plan year before insurance...

Outcome-Based Pay

Paying doctors based on the health results of the patient rather than the number of...

Outpatient Therapy

Therapeutic sessions provided in an office setting without an overnight stay.

Overtime Pay

Higher rate of pay (usually 1.5x) for hours worked beyond the legal limit.

P

Paid Time Off (PTO)

A bank of hours an employee can use for vacation sick or personal time.

Parental Leave

Time off for parents following the birth or adoption of a child.

Partial Hospitalization (PHP)

A structured program for patients who need intense care but not 24-hour supervision.

Participant

Any person (employee or dependent) who is enrolled in a benefit plan.

Passive Enrollment

When an employee's current benefits automatically roll over into the new year.

Patient Advocacy

A service that helps employees resolve billing errors and navigate the healthcare system.

Pay Equity Audit

A formal analysis to ensure employees are paid fairly regardless of gender race or ethnicity.

Pay Period

The timeframe for which an employee is being paid (e.g. weekly or monthly).

Payroll Deduction

Money taken directly from a paycheck to pay for benefits or taxes.

Payroll Frequency

How often employees are paid (e.g. weekly bi-weekly or semi-monthly).

PBM (Pharmacy Benefit Manager)

An entity that manages prescription drug programs and negotiates with manufacturers.

PCORI Fee

A small fee paid by health plan sponsors to fund patient-centered medical research.

Peer-to-Peer Review

A clinical discussion between a doctor and an insurance company’s medical director.

Personalized Benefits

A "choose-your-own" benefit model where employees spend a set budget on perks they value most.

Pet Insurance

Coverage for veterinary costs related to an employee's pets.

Pharmacist-In-Charge

The licensed pharmacist responsible for the legal operation of a specific pharmacy.

Pharmacy Benefit Manager [PBM]

A third-party administrator that processes prescription drug claims and manages the pharmacy benefits for health...

Plan Administrator

The entity responsible for managing the day-to-day operations of a benefit plan.

Plan Design

The specific structure of a health plan including its deductibles copays and rules.

Plan Year

The 12-month period for which a benefit plan's rules and deductibles apply.

Population Health

The health outcomes of a specific group of employees managed as a whole.

Portfolio

A grouping of financial assets such as stocks bonds and mutual funds.

Post-Tax Deduction

Money taken from a paycheck after taxes; does not lower taxable income.

PPO (Preferred Provider Organization)

A plan that allows you to see any doctor but offers lower costs if you...

Pre-Tax Deduction

Money taken from a paycheck before taxes; lowers the employee's taxable income.

Predictive Modeling

Using AI to forecast future health risks and high-cost claims within a workforce.

Premium

The fixed amount paid every month to keep your health insurance active.

Premium Waiver

A provision that stops premium payments if the policyholder becomes totally disabled.

Presenteeism

When employees are at work but not fully productive due to illness or stress.

Prior Authorization (Rx)

A requirement for a doctor to prove a drug is necessary before the plan pays.

Proactive Outreach

Contacting at-risk employees before a health issue becomes a high-cost claim.

Profit Sharing

A plan that gives employees a share in the profits of a company based on...

Pronoun Policy

Guidelines encouraging the use of preferred pronouns to foster a respectful and inclusive environment.

Proration

Adjusting a benefit or pay amount based on a partial period of time worked.

Provider

A physician hospital or other facility that provides health care services.

Psychiatrist

A medical doctor specialized in diagnosing and treating mental illness with medication.

Psychological Safety

A culture where employees feel safe to take risks and speak up without fear.

Psychologist

A professional specialized in mental processes and behavioral health through talk therapy.

Q

Qualified Life Event (QLE)

A change in life status (like marriage) that allows you to change benefits mid-year.

Qualified Plan

A benefit plan that meets IRS requirements for favorable tax treatment.

Quantity Limits

A restriction on the amount of a specific drug that can be dispensed over a...

R

RBP (Reference Based Pricing)

Paying a set multiple of Medicare rates for medical services.

Real-Time Integration

A tech connection that updates employee data across all benefit platforms instantly.

Rebate

A discount given by a drug manufacturer to a PBM in exchange for formulary placement.

Reference-Based Pricing [RBP]

A cost-containment strategy where the plan pays providers a set percentage (e.g., 140%) of Medicare...

Reinsurance

Insurance for insurance companies (or self-insured employers) to protect against massive claims.

Remote Work Stipend

Funds provided to remote employees for home office equipment internet or coworking spaces.

Residential Treatment

Long-term care in a facility for severe mental health or substance use issues.

Retroactive Adjustment

A payroll correction that applies to a previous pay period.

RMD (Required Minimum Distribution)

The minimum amount you must withdraw from your retirement account each year once you reach...

Roth Contribution

An after-tax retirement contribution that allows for tax-free withdrawals in retirement.

S

Sabbatical

A long-term break from work offered as a reward for tenure or mental health.

Safe Harbor

A legal provision that protects employers from penalties if they follow specific plan designs.

Safe Harbor 401(k)

A 401(k) plan design that allows employers to bypass certain annual compliance testing.

Salary

A fixed amount of annual pay regardless of the number of hours worked.

SBC (Summary of Benefits and Coverage)

An easy-to-read outline that lets you compare costs and coverage between health plans.

SBC (Summary of Benefits)

A standard easy-to-read document explaining what a health plan covers and costs.

Section 125 Plan

The tax code allowing employees to pay for benefits with pre-tax dollars.

SECURE 2.0

Federal legislation that updated retirement rules including student loan matching and emergency savings.

Self-Funded

A model where the employer pays for claims directly rather than buying traditional insurance.

Self-Funded [or Self-Insured] Plan

AKA a self-insured plan, refers to a type of health insurance plan in which the...

Semi-Monthly Payroll

A pay schedule where employees are paid twice a month (24 times a year).

Shared Savings

A model where providers keep a portion of the money they save the health plan.

Short-Term Disability (STD)

Provides partial income replacement if you are unable to work due to a short-term illness.

Single Sign-On (SSO)

A session and user authentication service that lets employees use one login for all benefit...

Skilled Nursing Care

Services that can only be safely and effectively performed by licensed nurses.

Social Wellness

Benefits that encourage community building volunteering and healthy workplace relationships.

SPD (Summary Plan Description)

The formal document explaining how a benefit plan works and what it covers.

Specialty Drug

High-cost complex medications often requiring special storage or administration.

Specialty Pharmacy

A pharmacy that focuses exclusively on high-cost high-touch specialty medications.

Spread Pricing

When a PBM charges an employer more than it pays the pharmacy keeping the difference.

Standard Industrial Classification (SIC)

A code used by insurers to determine risk based on the company's industry.

Step Therapy

A protocol requiring patients to try lower-cost drugs before "stepping up" to pricier ones.

Stipend

A fixed sum of money paid periodically for expenses or as a benefit.

Stop-Loss

Insurance that protects self-funded employers from claims that exceed a certain dollar amount.

Stop-Loss Insurance

Protection for self-funded employers. It limits the employer's liability by kicking in if an individual...

Substance Use Disorder (SUD)

A condition where the use of drugs or alcohol leads to significant impairment.

Summary of Material Modifications

A required notice sent to employees when there are significant changes to their benefits.

Summary of Material Modifications (SMM)

A document notifying participants of significant changes to a benefit plan.

Supplemental Life

Additional life insurance an employee can purchase beyond the employer-paid amount.

T

Target Date Fund (TDF)

A fund that automatically shifts to a more conservative investment mix as you approach retirement.

Tax Filing

The process of reporting payroll taxes to federal state and local governments.

Taxable Wage Base

The maximum amount of earnings on which certain taxes (like Social Security) are paid.

Telehealth Utilization

A metric measuring how often employees use virtual doctor visits versus in-person care.

Telepsychiatry

The delivery of psychiatric assessment and care via video conferencing.

Term

Definition

Termination Date

The last day of an employee’s employment which usually triggers benefit ends.

Therapeutic Class

A group of drugs used to treat the same medical condition or symptom.

Therapeutic Interchange

The substitution of a chemically different but therapeutically similar drug.

Third-Party Administrator

A company hired to process claims and manage the administrative side of a health plan.

Third-Party Administrator [TPA]

An independent entity hired by an organization to handle specific administrative functions or services. TPAs...

Total Drug Spend

The sum of all costs (employer + employee) for prescription drugs over a period.

Total Rewards

The combined value of an employee’s salary benefits and development perks.

Total Rewards Statement

A document showing the combined value of an employee's salary and all benefits.

Travel Assistance

Support services for employees traveling 100+ miles from home including medical referrals.

U

UCR (Usual

Reasonable) ucr The amount providers in a specific geographic area usually charge for a service.

Urgent Care

Care for an illness or injury that is serious but does not require an emergency...

Utilization Review

A data-driven evaluation of whether medical or drug services are necessary and efficient.

V

Value-Based Care

A healthcare model that rewards providers for the quality not quantity of care.

Vesting

The process by which an employee earns permanent ownership of employer-contributed funds.

Virtual-First Health Plan

A health plan where the primary point of contact for care is a virtual doctor.

Voluntary Benefits

Insurance products that are 100% employee-paid but offered at discounted group rates.

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