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Federal law that mandates health coverage standards and requires large employers to offer insurance.
A policy that pays a cash benefit directly to the employee following a specific physical...
The amount of retirement benefits a participant has earned to date based on plan rules.
A policy where manufacturer coupons do not count toward an employee's deductible.
An individual currently on the company payroll and eligible for benefits.
An enrollment where employees must choose a plan or they will have no coverage.
An investment strategy where a manager actively chooses stocks to beat market returns.
A device that monitors physical activity levels often integrated into wellness plans.
The percentage of total average costs for covered benefits that a plan will pay.
A customized one-time report created for a specific need or data request.
Pays a benefit if you die or lose a limb or eyesight due to an...
The degree to which a patient takes their medication exactly as prescribed.
A voluntary employee-led group based on shared characteristics or life experiences.
The ACA requirement that a health plan's premium not exceed a certain percentage of employee...
Money taken out of a paycheck after taxes are calculated (e.g. Roth 401k).
Insurance premiums that increase as the employee gets older.
Using artificial intelligence to guide employees to the highest quality lowest cost healthcare providers.
An employer with 50+ full-time employees required by the ACA to offer health insurance.
The maximum amount on which payment is based for covered health care services.
Financing models like self-insurance used to pay for healthcare.
The date on which a plan renews or an employee's eligibility increases.
A financial product that pays out a fixed stream of payments to an individual primarily...
Education designed to help employees recognize and mitigate unconscious prejudices.
Tech that allows an HR system to sync data directly with insurance carriers.
A life change that is legally allowed to trigger a special enrollment period.
Unpaid benefit premiums that are owed by an employee from a previous pay period.
The strategy of dividing your investment portfolio among stocks bonds and cash.
A feature that automatically signs employees up for the retirement plan unless they opt out.
A feature that automatically increases an employee’s 401k contribution percentage annually.
The benchmark price used by PBMs to calculate drug reimbursements and discounts.
A contract required by HIPAA to ensure vendors protect employee health data.
Short-term care solutions for children or elderly adults when primary care arrangements fall through.
When a provider bills you for the difference between the provider’s charge and the allowed...
A set amount of life insurance provided by the employer at little or no cost...
Coverage for routine eye exams and a limited allowance for glasses or contact lenses.
A broad term covering mental health services and substance use treatments.
The person designated to receive retirement funds if the employee passes away.
The legal process of naming who receives benefits upon an employee's death.
The use of data to evaluate the performance cost and engagement of benefit programs.
A master list of employee data used by brokers to get insurance quotes.
A grouping of employees (e.g. Executive or "Hourly") with different benefit levels.
Paid or unpaid time off provided to employees following the death of a family member.
A pay schedule where employees are paid every two weeks (26 times a year).
A generic drug that reaches the bloodstream at the same rate as the brand-name version.
A debt security where an investor lends money to an entity for a fixed interest...
A medication sold by the original manufacturer under a trademarked name.
A legal document designating a specific broker to represent the employer.
An option in a 401k plan allowing employees to buy stocks outside the standard fund...
A "flat-rate" price for a specific medical procedure (like a knee replacement) that includes the...
Organizational strategies to reduce employee exhaustion and stress.
An option for an employee to pay more to receive a higher level of coverage...
A plan allowing employees to choose between taxable cash and certain qualified benefits.
A form of self-insurance where a company creates its own 'mini' insurance company to provide...
Programs that coordinate care for employees with chronic conditions to improve outcomes.
Assistance for employees in finding the best quality care at the lowest cost.
Financial support provided to employees to help cover the costs of caring for family members.
An automated data file sent from an HR system to an insurance company.
When an employer separates a specific benefit (usually Prescription Drugs or Mental Health) from the...
When an employer separates the pharmacy benefit from the medical plan to use a specialized...
A process where a health professional coordinates care for an individual with complex medical needs.
Extra contributions allowed for employees age 50+ to boost their retirement savings.
A spreadsheet containing detailed employee demographics used for plan renewals.
A medical facility recognized for superior outcomes in a specific specialty.
An annual notice informing employees of potential state premium assistance for children.
The ability for employers to see the actual cost and data behind medical claims.
Deep data analysis of medical claims to identify trends gaps in care and savings opportunities.
A schedule where an employee becomes 100% vested only after a specific period of time.
The power of a drug to produce a desired medical effect under ideal conditions.
Federal law that lets you keep your group health insurance for a limited time after...
Your share of the costs of a covered health care service calculated as a percent.
The presence of two or more chronic conditions (e.g. depression and heart disease) in one...
A flat insurance rate charged regardless of the employee's age.
A custom-mixed medication created by a pharmacist for a specific patient's needs.
Interest calculated on both the initial principal and the accumulated interest from prior periods.
A schedule such as a 4/10 or 9/80 that allows employees to work full-time hours...
The tax principle where income is taxable when it is made available to the employee.
A non-permanent worker such as a freelancer or independent contractor.
A process to determine which plan pays first when a person is covered by more...
A fixed amount you pay for a covered health care service at the time of...
A code used in payroll to track which department is paying for an employee's benefits.
Apps or websites that allow employees to compare prices for medical procedures.
Professional guidance for individuals to help resolve personal or psychological problems.
Health coverage that is at least as good as the standard Medicare prescription drug plan.
Immediate short-term support for individuals in a mental health emergency.
A policy that pays a lump sum if you are diagnosed with a specific major...
Provides a lump-sum cash payment if you are diagnosed with a major illness like a...
Intensive mental health care where patients return home each evening.
Interactive tools that help employees choose the most cost-effective health plan during enrollment.
The amount you owe for health care services before your insurance begins to pay.
A label in the payroll system that determines the tax status of a benefit payment.
A traditional pension that promises a specific monthly benefit at retirement based on salary and...
A plan like a 401(k) where the retirement benefit depends on contributions and investment performance.
Diversity Equity Inclusion and Belonging; the four pillars of a modern workplace culture.
A dental plan that requires you to use a specific network dentist to receive coverage.
A dental plan that allows you to visit any dentist but offers discounts for in-network...
A process to verify that everyone enrolled as a dependent is legally eligible for coverage.
Tests or procedures (like X-rays or labs) performed to find the cause of a symptom.
An online-first pharmacy model that offers home delivery and transparent pricing.
Negotiating prices directly with hospitals cutting out the insurance carrier.
The electronic transfer of a net paycheck directly into a bank account.
A healthcare model where patients pay a monthly fee directly to their primary care physician...
Moving retirement funds directly from one plan to another to avoid taxes or penalties.
An employer contribution to a 401k that the company decides on a year-by-year basis.
The amount paid to a pharmacy for the professional service of filling a prescription.
A portion of a company's profit paid out to its shareholders.
Investing a fixed amount at regular intervals regardless of market price.
Traveling within the country to a COE for a specific surgery or treatment.
The groups (Tier 1 2 3 etc.) that determine an employee's copay based on the...
When an individual is covered by two health insurance plans simultaneously.
Medical equipment such as wheelchairs or oxygen tanks that can withstand repeated use.
Confidential counseling and referrals provided by the employer for personal or work issues.
The standard format for transferring benefit enrollment data between employers and carriers.
The Equal Employment Opportunity Commission which enforces federal laws against workplace discrimination.
The exact date an employee’s insurance coverage or benefit plan begins.
The portion of pay an employee chooses to contribute to a retirement plan pre-tax.
The criteria (like hours worked) an employee must meet to join a benefit plan.
The waiting period between the start of a disability and when benefit payments begin.
Services for a medical condition that requires immediate attention to prevent serious jeopardy.
A portal where employees can manage their own personal data and benefits.
The portion of a benefit premium or retirement match paid for by the company.
A health clinic located on or near a company's worksite for employee use.
The specific timeframe during which an employee can sign up for benefits.
A managed care plan where services are covered only if you use doctors in the...
Federal law that sets minimum standards for voluntarily established pension and health plans.
A health questionnaire required by insurers for high-value life insurance.
A specific drug or class of drugs that is not covered by the health plan.
An employee not entitled to overtime pay under the Fair Labor Standards Act.
The annual fee charged by an investment fund to cover its operating expenses.
A statement from your insurer explaining what medical treatments were paid for and what you...
Medical and social services for those with chronic illnesses or disabilities over a long period.
The average price for a medical service based on regional data rather than high list...
Support for paths to parenthood including IVF egg freezing adoption and surrogacy.
Coverage for treatments such as IVF egg freezing or specialized consultations.
Federal Insurance Contributions Act; the tax for Social Security and Medicare.
A person or entity legally required to act in the best interest of plan participants.
A PBM that is legally required to act in the employer’s best financial interest.
Programs that help employees manage debt budget and save for future goals.
The tax form used to report information about health insurance coverage offered by large employers.
The list of preferred prescription drugs covered by a specific health insurance plan.
Extra perks (like company cars) provided to employees beyond their base salary.
A unit of measurement used to determine if an employer is subject to ACA mandates.
Federal Unemployment Tax Act; an employer-paid tax for unemployment.
A legal process where a portion of a paycheck is withheld to pay a debt.
Health care services that support and affirm an individual's gender identity.
A low-cost version of a brand-name drug with the same active ingredients.
Clinical programs designed to manage the use and cost of weight-loss medications like Wegovy.
An entity that pools purchasing power to get better rates on medical supplies or drugs.
A health plan that existed before the ACA and is exempt from certain newer requirements.
A formal complaint filed by a participant regarding their health plan's operation or care.
The total amount an employee earns before any taxes or deductions are taken out.
The unique ID assigned by an insurance company to an employer’s specific plan.
Health care services that help a person keep learn or improve skills for daily living.
An emergency withdrawal from a retirement account for an immediate and heavy financial need.
A survey used to identify potential health risks in a workforce.
A report that measures the overall health and risk levels of an entire employee population.
Federal law protecting the privacy and security of an individual's personal health information.
A plan that usually limits coverage to care from doctors who work for or contract...
A benefits strategy that addresses physical mental financial and social health together.
Specialized care focused on the palliation of a terminally ill patient's symptoms.
A plan that pays a fixed cash amount for every day you are confined to...
An employee paid a set rate for every hour worked.
Human Resources Information System; software used to manage employee data.
A service that monitors your credit and helps restore your identity if it is stolen.
A service that monitors personal data and helps restore identity if it is stolen.
The value of a non-cash benefit that is considered taxable income by the IRS.
Providers and facilities that have a contract with your insurer to provide services at a...
Benefit designs that ensure equal access for LGBTQ+ neurodivergent and diverse family structures.
A claims administrator that is not owned by a major health insurance company.
A mutual fund designed to match or track the components of a specific market index.
Health care that you get when you are admitted as a patient to a hospital.
The ability of different HR and insurance computer systems to exchange and use data seamlessly.
A tax-advantaged account used by individuals to save for retirement.
A period of time an employee is away from work for medical or personal reasons.
Time away from work for reasons like maternity medical or military leave.
A plan providing access to attorneys for common personal legal matters like wills or traffic...
Pre-paid access to attorneys for common personal legal issues like wills or house closings.
A type of health insurance plan that combines aspects of self-funding and traditional fully insured...
A hybrid plan where employers pay a fixed monthly fee that covers all insurance costs.
A change (like marriage) that allows for mid-year benefit changes; see also QLE.
An employer-funded account for health and lifestyle expenses.
Provides income replacement for severe long-term disabilities that prevent working.
A method to determine full-time status for ACA compliance over a set period.
A timeframe used to determine if an employee counts as full-time for ACA purposes.
Medical services that provide little to no benefit to the patient given their cost.
The upper limit a plan will pay for generic or multi-source brand drugs.
Medication taken on a long-term basis for chronic conditions like diabetes.
Benefits that are required by federal or state law to be included in an insurance...
A physical paycheck written outside of the normal automated payroll cycle.
Money an employer adds to an employee's 401k based on the employee's own contribution level.
The highest amount allowed by the IRS to be put into a 401k or HSA.
The total limit an employee will pay for covered services in a plan year.
A requirement that insurance companies spend at least 80-85% of premium dollars on medical care/quality...
Health care services or supplies needed to prevent diagnose or treat an illness or injury.
A law requiring mental health benefits to be equal to medical/surgical benefits.
Small funds provided for short specific skill-building courses or certifications.
Digital tools provided to employees to help with meditation and stress reduction.
The basic level of health insurance required to satisfy the ACA's individual mandate.
A health plan that covers at least 60% of total allowed costs for standard benefits.
A medication that has at least one generic equivalent available on the market.
An investment vehicle made up of a pool of money from many investors to buy...
The actual cost of a drug to the employer after all PBM rebates are subtracted.
A smaller curated group of providers that offers lower costs for higher quality.
A health center located close to a company for employees and their families.
The discounted price an insurance company has agreed to pay a provider for a service.
The final cost of healthcare after all discounts rebates and fees are applied.
Take-home pay after all taxes and benefit deductions have been removed.
A pharmacy that has a contract to provide drugs to plan members at a discount.
The concept that neurological differences (like ADHD or Autism) are natural variations of the human...
The process of integrating a new employee and enrolling them in benefits.
An employee who must be paid overtime for hours worked over 40 per week.
A healthcare provider who does not have a contract with your insurance company.
A drug not on the formulary list usually requiring a much higher copay.
Annual IRS tests to ensure benefit plans do not favor highly compensated employees.
A pay run performed outside of the normal scheduled dates.
A benefit allowing employees to access their earned wages before the scheduled payday.
The annual window when employees can review and change their benefit selections.
The annual window to sign up for or change workplace benefits.
When employees participate in benefits because they find value not just for rewards.
Providers who do not have a contract with your health insurance plan.
The most you have to pay for covered services in a plan year before insurance...
Paying doctors based on the health results of the patient rather than the number of...
Therapeutic sessions provided in an office setting without an overnight stay.
Higher rate of pay (usually 1.5x) for hours worked beyond the legal limit.
A bank of hours an employee can use for vacation sick or personal time.
Time off for parents following the birth or adoption of a child.
A structured program for patients who need intense care but not 24-hour supervision.
Any person (employee or dependent) who is enrolled in a benefit plan.
When an employee's current benefits automatically roll over into the new year.
A service that helps employees resolve billing errors and navigate the healthcare system.
A formal analysis to ensure employees are paid fairly regardless of gender race or ethnicity.
The timeframe for which an employee is being paid (e.g. weekly or monthly).
Money taken directly from a paycheck to pay for benefits or taxes.
How often employees are paid (e.g. weekly bi-weekly or semi-monthly).
An entity that manages prescription drug programs and negotiates with manufacturers.
A small fee paid by health plan sponsors to fund patient-centered medical research.
A clinical discussion between a doctor and an insurance company’s medical director.
A "choose-your-own" benefit model where employees spend a set budget on perks they value most.
Coverage for veterinary costs related to an employee's pets.
The licensed pharmacist responsible for the legal operation of a specific pharmacy.
A third-party administrator that processes prescription drug claims and manages the pharmacy benefits for health...
The entity responsible for managing the day-to-day operations of a benefit plan.
The specific structure of a health plan including its deductibles copays and rules.
The 12-month period for which a benefit plan's rules and deductibles apply.
The health outcomes of a specific group of employees managed as a whole.
A grouping of financial assets such as stocks bonds and mutual funds.
Money taken from a paycheck after taxes; does not lower taxable income.
A plan that allows you to see any doctor but offers lower costs if you...
Money taken from a paycheck before taxes; lowers the employee's taxable income.
Using AI to forecast future health risks and high-cost claims within a workforce.
The fixed amount paid every month to keep your health insurance active.
A provision that stops premium payments if the policyholder becomes totally disabled.
When employees are at work but not fully productive due to illness or stress.
A requirement for a doctor to prove a drug is necessary before the plan pays.
Contacting at-risk employees before a health issue becomes a high-cost claim.
A plan that gives employees a share in the profits of a company based on...
Guidelines encouraging the use of preferred pronouns to foster a respectful and inclusive environment.
Adjusting a benefit or pay amount based on a partial period of time worked.
A physician hospital or other facility that provides health care services.
A medical doctor specialized in diagnosing and treating mental illness with medication.
A culture where employees feel safe to take risks and speak up without fear.
A professional specialized in mental processes and behavioral health through talk therapy.
A change in life status (like marriage) that allows you to change benefits mid-year.
A benefit plan that meets IRS requirements for favorable tax treatment.
A restriction on the amount of a specific drug that can be dispensed over a...
Paying a set multiple of Medicare rates for medical services.
A tech connection that updates employee data across all benefit platforms instantly.
A discount given by a drug manufacturer to a PBM in exchange for formulary placement.
A cost-containment strategy where the plan pays providers a set percentage (e.g., 140%) of Medicare...
Insurance for insurance companies (or self-insured employers) to protect against massive claims.
Funds provided to remote employees for home office equipment internet or coworking spaces.
Long-term care in a facility for severe mental health or substance use issues.
A payroll correction that applies to a previous pay period.
The minimum amount you must withdraw from your retirement account each year once you reach...
An after-tax retirement contribution that allows for tax-free withdrawals in retirement.
A long-term break from work offered as a reward for tenure or mental health.
A legal provision that protects employers from penalties if they follow specific plan designs.
A 401(k) plan design that allows employers to bypass certain annual compliance testing.
A fixed amount of annual pay regardless of the number of hours worked.
An easy-to-read outline that lets you compare costs and coverage between health plans.
A standard easy-to-read document explaining what a health plan covers and costs.
The tax code allowing employees to pay for benefits with pre-tax dollars.
Federal legislation that updated retirement rules including student loan matching and emergency savings.
A model where the employer pays for claims directly rather than buying traditional insurance.
AKA a self-insured plan, refers to a type of health insurance plan in which the...
A pay schedule where employees are paid twice a month (24 times a year).
A model where providers keep a portion of the money they save the health plan.
Provides partial income replacement if you are unable to work due to a short-term illness.
A session and user authentication service that lets employees use one login for all benefit...
Services that can only be safely and effectively performed by licensed nurses.
Benefits that encourage community building volunteering and healthy workplace relationships.
The formal document explaining how a benefit plan works and what it covers.
High-cost complex medications often requiring special storage or administration.
A pharmacy that focuses exclusively on high-cost high-touch specialty medications.
When a PBM charges an employer more than it pays the pharmacy keeping the difference.
A code used by insurers to determine risk based on the company's industry.
A protocol requiring patients to try lower-cost drugs before "stepping up" to pricier ones.
A fixed sum of money paid periodically for expenses or as a benefit.
Insurance that protects self-funded employers from claims that exceed a certain dollar amount.
Protection for self-funded employers. It limits the employer's liability by kicking in if an individual...
A condition where the use of drugs or alcohol leads to significant impairment.
A required notice sent to employees when there are significant changes to their benefits.
A document notifying participants of significant changes to a benefit plan.
Additional life insurance an employee can purchase beyond the employer-paid amount.
A fund that automatically shifts to a more conservative investment mix as you approach retirement.
The process of reporting payroll taxes to federal state and local governments.
The maximum amount of earnings on which certain taxes (like Social Security) are paid.
A metric measuring how often employees use virtual doctor visits versus in-person care.
The delivery of psychiatric assessment and care via video conferencing.
Definition
The last day of an employee’s employment which usually triggers benefit ends.
A group of drugs used to treat the same medical condition or symptom.
The substitution of a chemically different but therapeutically similar drug.
A company hired to process claims and manage the administrative side of a health plan.
An independent entity hired by an organization to handle specific administrative functions or services. TPAs...
The sum of all costs (employer + employee) for prescription drugs over a period.
The combined value of an employee’s salary benefits and development perks.
A document showing the combined value of an employee's salary and all benefits.
Support services for employees traveling 100+ miles from home including medical referrals.
Reasonable) ucr The amount providers in a specific geographic area usually charge for a service.
Care for an illness or injury that is serious but does not require an emergency...
A data-driven evaluation of whether medical or drug services are necessary and efficient.
A healthcare model that rewards providers for the quality not quantity of care.
The process by which an employee earns permanent ownership of employer-contributed funds.
A health plan where the primary point of contact for care is a virtual doctor.
Insurance products that are 100% employee-paid but offered at discounted group rates.
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