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Reference
Glossary
Glossary
annual enrollment
– a period specified by Aflac during
which you may change the plan options and benefits
in which you are enrolled, as long as any change is
consistent with plan eligibility rules and federal regulations.
catch-up contributions
– additional 401(k) contribu-
tions that people age 50 or older can make after reaching
the federal limit on annual 401(k) contributions. Federal
law permits catch-up contributions to encourage people
nearing retirement to expand their retirement savings.
certificate of creditable coverage
– a document that
verifies prior health care coverage. This certificate usually
reduces how long a health care plan may exclude you
from coverage for a pre-existing health condition.
co-pay or co-payment
– a fixed-dollar amount that you
pay each time you receive specified health-care services
or prescription drugs.
covered service or covered expense
– a service or
supply, or a charge for a service or supply, that is eligible
for payment under a plan.
co-insurance
– the percentage of the cost that you or
the plan pays for a covered medical expense after you
have met your annual deductible.
deductible
– the amount of covered expenses that you
are responsible to pay each calendar year before the plan
starts paying.
domestic partner
– your same-gender or opposite-
gender domestic partner with whom you have registered
under a domestic partnership law or to whom you are
married under a same-sex marriage law. Registration or
same-sex marriage may be in any jurisdiction that legally
allows domestic partnerships or same-sex marriage.
You must provide documentation of the registration
or same-sex marriage to the Benefits Department.
Employees seeking coverage for a domestic partner
cannot be legally married to an opposite-sex spouse.
eligible dependents
– your lawful spouse, your registered
domestic partner, and your child(ren) as defined under each
plan. See the specific plan sections of this guide for details.
explanation of benefits or EOB
– a statement from
your health plan that explains the benefit calculation and
payment of medical services. An explanation of benefits
lists charges submitted, amount allowed, amount paid by
the plan and any balance owed by the patient.
Employee Retirement Income Security Act
– known
more commonly as ERISA, enacted in 1974 to protect
the interests of employee benefit plan participants and
their beneficiaries. ERISA requires disclosure of financial
and other plan information to participants, sets standards
of conduct for plan fiduciaries, and provides for appro-
priate remedies and access to the federal courts.
flexible spending account
– an employee benefit
program that allows you to set aside untaxed money from
your pay and reimburse yourself for eligible health-care and
dependent “day care” expenses. This allows you to spend
the dollars that you otherwise would have paid in income
taxes. The accounts are separate bookkeeping accounts.
formulary
– a drug list used as a guide to determine the
amount of your co-pay for each prescription medication
that you purchase. Drugs listed in the formulary are
typically available to you at a lower co-pay than those that
are not listed. A formulary may also be called a preferred
drug list.
generic drugs
– prescription drugs that are chemically
equivalent to brand-name products and dispensed under
their generic chemical names, usually at a lower cost.
HMO or Health Maintenance Organization
– a
healthcare delivery system that typically uses contracted
primary care physicians to coordinate all health care for
enrolled participants. An HMO coordinates your care and
refers you to specialists and hospitals. Covered services
are usually paid in full after you pay any required co-pay.
No claim forms are required.
in-network
– a group of medical-, dental- or vision-care
providers who are members of a service administra-
tor’s network. The service administrator has a pricing
arrangement with the group that helps to hold down the
cost of the services received.
inpatient
– treatment in a hospital or facility for which a
room and board charge is made.
medically necessary or medical necessity
— a
healthcare service or treatment that’s generally accepted
in medical practice as needed for the diagnosis or
treatment of a patient’s condition and that can’t be
omitted without harming the patient (as judged against
generally accepted standards of medical practice).
Medical necessity is defined under the terms of the Aflac
Employee Health Plan.
