Glossary

  • Brand Name Drug:

    A drug that is patented and produced only by one manufacturer.

  • COBRA:

    A federal law that may allow you to temporarily keep 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 100% of the premiums, including the share Segal used to pay, plus a small administrative fee.

  • Coinsurance:

    Money that you are required to pay for services, generally after you have met your deductible. Coinsurance is often specified by a percentage.

  • Contribution:

    The net out-of-pocket amount you pay each pay period for health care coverage.

  • Copay:

    Copay is a predetermined (flat) fee that you pay for health care services, in addition to what the plan covers.

  • Coverage Tier:

    The level of coverage that indicates who is covered under your medical, dental, and vision options. Tiers include Employee Only, Employee Plus One and Employee Plus Family.

  • Deductible:

    The deductible is the amount you must pay for health care expenses before the plan starts to cover the costs.

  • Dependent:

    A dependent is a person covered by your benefit elections and may include your legal spouse, spousal equivalent/domestic partner, and/or children through the end of the month in which they attain age 26.

  • Dependent Care Flexible Spending Account (DCFSA):

    A plan that allows you to set aside pre-tax contributions from your paychecks to pay the cost of day care for eligible dependents.

  • Employee Assistance Program (EAP):

    An employment-based plan designed to help you cope with issues such as work/life balance, stress, and grief. The plan offers employees counseling assistance by telephone, and may also cover follow-up visits with counselors if needed.

  • EPO:

    An EPO, or exclusive provider organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from. However, if you choose to get care outside of your plan's network, it usually will not be covered (except in an emergency).

  • Flexible Spending Account (FSA):

    A plan that allows you to set aside pre-tax dollars for common health care and/or dependent day care expenses. You must use Dependent Care FSA funds by the end of the plan year or they will be lost. For your Health Care FSA, you may roll over up to 20% of unused funds from one year to the next.

  • Formulary:

    A list of drugs your insurance plan covers. It may include how much you pay for each drug. Formularies may include both generic drugs and brand name drugs.

  • Generic Drug:

    A drug that does not have the trademark of the original manufacturer. It is chemically identical to and generally costs less than its brand name counterpart.

  • Health Assessment:

    A health questionnaire that asks about your health habits to help identify some of your health needs.

  • Health Care Flexible Spending Account (HCFSA):

    An account you may establish to set aside pre-tax contributions from your paychecks to pay eligible health care expenses.

  • Health Insurance Portability and Accountability Act of 1996 (HIPAA):

    A federal law that protects healthcare coverage for individuals who lose or change their jobs. It also requires the healthcare industry to become more efficient by encouraging the use of electronic media for transmission of certain patient administrative data. It also creates the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care.

  • Health Reimbursement Account (HRA):

    An employer funded arrangement from which employees are reimbursed tax free for qualified medical expenses up to a fixed dollar amount per year. 

  • Health Savings Account (HSA):

    A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.  By using untaxed HSA dollars to pay for deductibles, copayments, coinsurance, and some other eligible expenses, you may be able to lower your overall health care costs. HSA funds rollover year to year if you don't spend them so they also allow you to save for future health care expenses. You may contribute to an HSA only if you enrolled in an HSA-eligible High Deductible Health Plan.

  • High Deductible Health Plan (HDHP):

    A plan that features higher deductibles than traditional insurance plans. HDHPs that meet the Federal government minimum deductible and maximum out-of-pocket cost limits can be combined with a Health Savings Account (HSA).

  • HMO:

    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.  An HMO may require you to live or work in its service area to be eligible for coverage.

     

     

  • In-Network:

    Providers or health care facilities that are part of a health plan's network of providers through which it has negotiated a discount.  Insured individuals usually pay less when using an in-network provider.

  • Long-Term Disability (LTD):

    Insurance that pays you a percentage of your monthly earnings if you are unable to work due to a non-work related illness or injury for an extended length of time.

  • No Surprises Act:

    The No Surprises Act was signed into law December 27, 2020, as part of the Consolidated Appropriations Act of 2021 to protect participants in health benefit plans from surprise medical bills for emergency and non-emergency medical care, including air ambulance services. 

    The No Surprises Act, which amends ERISA, the Public Health Service Act and the Internal Revenue Code was originally intended to be effective January 1, 2022, and portions of the Act have been delayed.  The No Surprises Act prevents surprise billing of patients who receive emergency services in the emergency department of a hospital, at an independent freestanding emergency department and from air ambulances. In addition, the law protects patients who receive certain non-emergency services from an out-of-network provider at an in-network facility.

  • Out-of-Network:

    Physicians, hospitals or other health care providers who do not participate in an insurer's provider network.  This means that the provider has not signed a contract agreeing to accept the insurer's negotiated prices.  Expenses incurred for services provided by out-of-network health professionals may not be covered or may only be partially covered by an individual's insurance plan.  

     

     

  • Out-of-Pocket Maximum:

    The most you have to pay for covered services in a plan year.  After you spend this amount on deductibles, copayments, and coinsurance for covered services, your health plan pays 100% of the cost of covered benefits.

     

     

  • Patient Protection and Affordable Care Act (PPACA):

    Also known as the Affordable Care Act or ACA, this is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The legislation includes a long list of health-related provisions that began taking effect in 2010.

  • Preferred Provider Organization (PPO):

    A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers.  You pay less if you use providers that belong to the plan's network.  You can use doctors, hospitals, and providers outside of the network for an additional cost.

     

     

  • Preventive Drug:

    Preventive drugs are used to help avoid disease and maintain health. Under the Affordable Care Act, certain preventive medications are covered at no cost to eligible members.

    The U.S. Preventive Services Task Force defines the list of preventive prescription drugs.

     

  • Short-Term Disability (STD):

    Insurance that pays a percentage of your weekly earnings if you are unable to work for a short-term period due to non-work related illness or injury.

  • Telehealth:

    Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care.

  • Transparency Rule:

    The Transparency Rule was signed into law November 12, 2020 and requires plans and insurance issuers to disclose cost-sharing information, negotiated rates for in-network providers, and allowed amounts for out-of-network providers. Implementation of the Transparency Rule is being phased in.

  • Urgent Care Provider:

    A provider that performs services for health problems that require immediate medical attention but are not life-threatening emergencies.

This brochure contains information about the medical plan options and other benefits Segal Group offers. If any statements contained herein are inconsistent with applicable laws and regulations or official plan documents and contracts, those regulations and documents will govern. Segal Group reserves the right to amend or terminate any plan, at any time, for any reason. No provision of any benefit is to be considered a contract of employment between you and Segal Group.

© 2024-2025 by The Segal Group, Inc. The information in this overview offers only brief highlights of the 2019 benefits plans. In the event of a conflict between this overview and the plan documents or policies, the plan documents or policies will govern.