Glossary of Terms...
A B C D E F G H I K L M N O P Q R S T U V W
A
Actively-at-Work Clause.A plan provision that delays eligibility for employees who are not actively at work (often for health-related reasons) at the time coverage under a Group Health Plan would otherwise begin. A Non-Confinement Clause is a related provision.
AD&D Plan. A plan that provides benefits in the event of an accidental death or dismemberment (generally, an accident that results in death, loss of part of the body, or the loss of the use of part of the body).
ADA. The federal Americans with Disabilities Act, which generally prohibits a covered employer from discriminating against a qualified individual with a disability, on the basis of the disability, with respect to (among other things) fringe benefits such as health coverage.
Additional Child Tax Credit (ACTC). Under Code § 24, a refundable tax credit for individuals who cannot take advantage of the entire Child Tax Credit because their tax liability is too low.
ADEA.The federal Age Discrimination in Employment Act, which generally prohibits a covered employer from discriminating against an individual who is age 40 or older with respect to (among other things) employee benefits such as health coverage because of the individual's age.
Administrative Simplification. HIPAA's rules regarding privacy, security and Electronic Data Interchange Standards.
Administrative-Services-Only (ASO). An arrangement under which an insurance company or other third party provides administrative services, while the financial risk for benefit payments remains with the employer.
Adoption Assistance Plan. A written plan that meets the requirements of Code § 137 and provides adoption assistance benefits that are excludable from an employee's income, funded either by the employer or by the employee with salary reduction dollars.
Adoption Tax Credit. Under Code § 23, a tax credit for certain adoption-related expenses.
Affiliated Covered Entities. Under HIPAA, two or more legally-separate Covered Entities that are under common ownership or control (as defined in HIPAA s Administrative Simplification provisions) and designate themselves as a single Covered Entity.
Affiliated Service Group. Two or more organizations that are treated as a single employer for certain purposes under the Code based on common ownership, joint activity, or both, as defined in Code § 414(m).
Affiliation Period.A period of time that must expire before health insurance coverage provided by an HMO becomes effective and during which time the HMO is not required to provide benefits.
After-Tax Contributions. Contributions deducted from an employee's compensation after the compensation has been taxed.
Alternate Recipient.A child of a Participant who is recognized under a medical child support order as having a right to enrollment under a Group Health Plan with respect to the Participant.
Americans With Disabilities Act (ADA). A federal law enacted in 1991 that, among numerous provisions, prohibits discrimination in health coverage against persons with disabilities.
Annual Report. A report required of certain plan information, prepared using the Form 5500 series and required schedules and filed with the federal government.
Assignment of Benefits. A health plan Participant's or Beneficiary's direction to pay benefits directly to a specific person or institution, most frequently a health care provider.
Authorization. Under HIPAA, a document that authorizes the use or disclosure of an individual's Protected Health Information by a Covered Entity for any purpose described in the document and meets specific requirements.
B
Beneficiary. A person designated by a participant, or by the terms of an employee benefit plan, who is or may become entitled to a benefit under the plan.
Bona fide association. Regarding health insurance coverage issued in a state, an association that: (l) has been actively in existence for five years; (2) has been formed and maintained in good faith for purposes other than health insurance; and (3) does not condition membership or offer health coverage based on health-status related factors.
Bona fide wellness program. A program of health promotion and disease prevention.
Bonding Requirement.The requirement, under ERISA, that every Fiduciary of an Employee Benefit Plan and every person (except a bank or insurance carrier) who handles funds or other property of a plan must be covered by a fidelity bond. ERISA provides specific requirements as to the amount of the bond.
Business Associate. Under HIPAA, a third party that assists a Covered Entity in performing a function or activity regulated by HIPAA's Administrative Simplification rules or that provides certain services (for example, legal or consulting services) involving the use or disclosure of Individually Identifiable Health Information.
C
Cafeteria Plan.A written plan that meets the requirements of Code §125 and offers eligible employees a choice between cash and certain nontaxable benefits (such as health insurance), thereby allowing employees to pay for the benefits they choose on a pre-tax basis.
Calendar year. A year that ends on December 3l.
Capitation. A predetermined, fixed amount that is paid to a health care provider for each person served under the plan, regardless of the number of visits or extent of treatment.
Centers for Medicare and Medicaid Services (CMS). The agency within the U.S. Department of Health and Human Services (HHS) responsible for developing and implementing policies governing the Medicare and Medicaid programs, as well as HIPAA's EDI and security rules. Was formerly known as the Health Care Financing Administration.
Certificate of Creditable Coverage.Under HIPAA, a certificate that must be furnished by Group Health Plans, Health Insurance Issuers, and certain other entities to individuals who lose health coverage. The certificate documents the individual's Creditable Coverage.
CFR. The Code of Federal Regulations, which is the official compilation of regulations issued by the departments and agencies of the federal government.
Change in family status. Cafeteria plan participants are allowed to change their benefits elections if a change in family status occurs. Such changes include marriage, divorce, death, birth, adoption and significant change in employment.
Child Tax Credit (CTC). Under Code § 24, a non-refundable credit against tax liability that a taxpayer may be able to claim for a qualifying child.
Church Plan.A plan established and maintained for its employees (or their beneficiaries) by a church or by a convention or association of churches that is exempt from tax under Code § 501. Special rules apply to church plans.
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS). Provides health coverage for the families of members of the armed services, including the families of reservists called for active duty. Now known as TRICARE.
Claim denial appeal procedure. ERISA requires that summary plan descriptions explain the steps that a participant may take if a claim for a welfare or pension benefit is denied partially or wholly. The procedure includes the participant's rights to review the denied claims and the time frame for the plan administrator's response.
Co payment.The percentage of the cost of medical or other treatment that is not paid by the insurer, and so must be paid by the insured party, usually after the insured party pays a deductible amount.
COBRA continuation coverage. See Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).
COBRA Coverage.Continuation coverage that must be made available in certain circumstances to Qualified Beneficiaries under a Group Health Plan that is subject to COBRA.
COBRA. The federal Consolidated Omnibus Budget Reconciliation Act of 1985, which established, among other things, the continuation coverage rules for Group Health Plans that are found in ERISA, the Code and the PHSA.
Code §125 Plan. See Cafeteria Plan.
Code §213(d) Expenses. Certain expenses that are for medical care, as further defined in Code § 213(d).
Code Set. Under HIPAA, a set of designations used to encode data elements such as tables of terms, medical concepts, medical diagnosis codes, or medical procedure codes.
Code. The Internal Revenue Code of 1986, as amended.
Co-Insurance. A cost-sharing arrangement under a health plan under which a covered person pays a specified percentage of the cost of a specified service, such as 20% of the cost of a doctor's office visit.
Collectively bargained plan.An employee benefit plan negotiated between a union and an employer.
Common-law employee. An employed individual for whom income and employment taxes are withheld by the employer for which the services are directly performed. Generally, the employer/employee relationship exists in cases in which the employer has the right to control and direct the individual who performs the services, not only as to the result to be accomplished, but also as to the details and means by which that result is to be accomplished.
Community rating.A method of determining premium rates based on the allocation of total costs without regard to past group experience.
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). A federal law requiring certain employers that offer group health plans to provide continuation coverage to employees and their dependents who incur certain qualifying events.
Constructive Receipt. A tax law doctrine under which an employee who is given a choice between cash and nontaxable benefits (e.g., employer provided health insurance) must include in gross income the cash that could have been received. Code § 125 provides a safe harbor from constructive receipt for employees who choose nontaxable benefits instead of cash under a Cafeteria Plan.
Consumer-Driven Health Care (CDHC).An arrangement intended to encourage cost-conscious use of health care by giving individuals a financial stake in reducing their health care costs (e.g., by increasing their insurance Deductible and/or providing access to a medical savings/reimbursement account). Defined Contribution (DC) Health Plan is a related term that is sometimes used to describe an employer-provided consumer-driven health care arrangement.
Controlled group.A group of corporations, trades or businesses, each of which is at least 80 percent owned (either directly or through one or more chains of subsidiary corporations) by a common parent corporation or a group of five or fewer individuals, estates or trusts.
Conversion Coverage. Individual insurance coverage that is sometimes offered to employees or dependents who lose employer-provided group insurance coverage.
Coordination of benefits.A method of integrating benefits payable under more than one health plan so that the insured's benefits from all sources do not exceed 100 percent of allowable medical expenses.
Co-Payment. A cost-sharing arrangement under a health plan under which a covered person pays a specified dollar amount for a specified service, such as $10 for a prescription or $20 for a doctor's office visit. Also called a co-pay.
Covered Entity. An entity subject to HIPAA's Administrative Simplification mandates. The term includes health plans (as defined in HIPAA), Health Care Clearinghouses, health care providers, and endorsed sponsors of the Medicare prescription drug discount card that conduct Covered Transactions electronically.
Covered Transaction.Under HIPAA, one of a specified list of information transmissions that must comply with HIPAA's Electronic Data Interchange (EDI) Standards if conducted electronically by a Covered Entity or a Business Associate.
Creditable coverage. Generally, creditable coverage includes coverage under employer health plans, other health insurance, public health plans, Social Security and certain other sources. It does not include coverage that is not general health insurance or health coverage for limited benefits.
D
Deductible. A predetermined amount that must be paid by the plan participant for costs incurred before claims are paid by the insurer.
Defined Contribution (DC) Health Plan.An employer-provided Consumer-Driven Health Care arrangement intended to encourage the efficient use of health care by fixing employer contributions at a certain level (the "defined contribution"), rather than promising a specified benefit regardless of cost.
De-Identified information.Under HIPAA, Health Information with respect to which a Covered Entity has obtained a professional statistical analysis that such information is not Individually Identifiable Health Information or has deleted 18 specific identifiers (e.g., name, Social Security number, address, ZIP code).
Delinquent Filer Voluntary Compliance (DFVC) Program.A DOL program under which plan administrators may correct late or un filed Form 5500s by filing a completed Form 5500 for the year in question and paying a reduced, predetermined penalty.
Dependent Care Assistance Program (DCAP). A written plan that meets the requirements of Code § 129, under which employees are provided with dependent care assistance. Most DCAPs are Flexible Spending Arrangements (FSAs) offered under a Cafeteria Plan.
Dependent care plan.An employee benefit that provides assistance to employees through: (1) cash reimbursements for dependent care expenses incurred by employees; (2) payments directly to day care centers made on behalf of employees; or (3) on-site dependent care facilities.
Dependent Care Tax Credit (DCTC). Under Code § 21, a non-refundable credit against tax liability that a taxpayer may be able to claim, if the taxpayer has certain employment-related dependent care expenses.
Dependent coverage. Health coverage designed to include the dependents of employees.
Dependent. A spouse, natural child, adopted child, foster child, stepchild or legal ward of a covered employee under Code Section 152.
Designated record sets under HIPAA. Information maintained by a covered entity, to include: medical records; billing records; enrollment, payment, claims adjudication and case or medical management record systems maintained by or for a health plan; or records used by or for the covered entity to make decisions about individuals.
Disability plan (short or long term disability). An employer-provided plan in which income replacement payments are made to an employee who cannot work due to illness or injury.
Disability. A condition in which an employee is unable to perform one or more of the duties related to his or her job due to a medically determinable physical or mental impairment. A person is deemed to be totally disabled under the Social Security Act if it can be expected that the impairment will result in death or “has lasted or can be expected to last for a continuous period of not less than 12 months.”
DOL. The U.S. Department of Labor.
Domestic Partner. An individual's unmarried partner of the same or opposite sex.
E
Earned Income Credit (EIC). Under Code § 32, a refundable tax credit available to certain low-income taxpayers.
EBSA. The Employee Benefits Security Administration, formerly known as the Pension and Welfare Benefits Administration (PWBA). EBSA is an agency of the DOL.
EEOC. The U.S. Equal Employment Opportunity Commission.
EFAST. The ERISA Filing Acceptance System, which is a computerized system designed to simplify and expedite the federal government's receipt and processing of Form 5500s by using computer scannable forms and electronic filing technologies. ERISA
EGTRRA. The federal Economic Growth and Tax Relief Reconciliation Act of 2001.
Election form. A form used to elect coverage under a benefit plan.
Election period. The amount of time that an individual has to elect coverage under a benefit plan.
Electronic Data Interchange (EDI) Requirements. Under HIPAA, rules requiring Covered Entities and Business Associates to use standardized formats, content and Code Sets when conducting Covered Transactions electronically.
Electronic media. A mode of electronic transmission, including telephone voice response, faxback systems, Hyper Text Markup Language (HTML) interactions, the Internet (wide-open), extranets, leased lines, dial-up lines, private networks and transmissions physically moved from one location to another using magnetic tape, disk or compact disk media.
Electronic Payment Card.A debit card, stored value card, or credit card that allows a Participant to access funds in a Health FSA, Health Savings Account or Health Reimbursement Arrangement to pay the service provider at the point-of-sale (i.e., the time a service or item is provided).
Electronic PHI. Under the security provisions of HIPAA's Administrative Simplification rules, Protected Health Information that is transmitted by or maintained in electronic media.
Eligibility Requirements. The age, service, and other requirements specified by a plan document as pre-conditions to an employee's participation.
Eligibility. Conditions that must be met to qualify for coverage under a plan, such as length of service, full-time status or attaining a certain minimum age.
Eligible individual. Generally, an individual who is eligible to enroll in a group health or other benefit plan.
Employee Assistance Program (EAP). Usually, a program staffed by trained counselors who provide some form of counseling to eligible employees and their family members.
Employee benefit plan. Under ERISA, a welfare benefit or pension benefit plan maintained by an employer (or group of employers).
Employee Retirement Income Security Act of 1974 (ERISA). A federal law primarily enacted to enforce pension equality. ERISA subjects individuals and employers that administer, supervise or manage employee welfare benefit plans to numerous responsibilities.
Employer contribution rule. A requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries.
Employer. Any person acting directly as an employer, or indirectly in the interest of an employer, in relation to an employee benefit plan. Includes a group or association of employers acting for an employer in such capacity.
Employmentrecords. Records held by an employer in its capacity as an employer, rather than as a plan sponsor. Such records are not considered PHI.
End-stage renal disease (ESRD). Permanent kidney failure.
Enroll. To become covered for benefits under a group health or other plan (that is, when coverage becomes effective) without regard to when the individual may have completed or filed any forms that are required in order to enroll in the plan.
Enrollment Date. Under IDPAA, the first day of coverage under a Group Health Plan for a Late Enrollee or Special Enrollee; for a Regular Enrollee, the first day of coverage under a Group Health Plan or, if there is a Waiting Period, the first day of the Waiting Period.
Entitlement, Medicare. Individuals become entitled to Medicare once they actually apply to begin Social Security income payments or file an application for hospital insurance benefits under Part A of Medicare.
Equal Employment Opportunity Commission (EEOC). A commission of the federal government charged with enforcing various civil rights provisions, including the Americans With Disabilities Act.
Escheat Laws.State laws that consider the state to be the owner of property where there is no owner or the property has been abandoned. Also see Unclaimed Property Laws.
Estoppel . An equitable claim in which an individual states that a party is prevented from taking a particular action because the individual, to his or her detriment, relied on certain promises (or misrepresentations) that the party made.
Evidence of insurability. Many insurance companies require prospective clients/ individuals to prove that they are in good health and are therefore good insurance risks before the company will cover them.
Excepted benefits. Certain benefits, such as workers' compensation, automobile insurance and disability income insurance, which are excluded from HIP AA' s portability provisions.
Exclusions. Specific conditions or circumstances listed in a health or other plan for which the plan will not provide benefit payments or coverage.
Exclusive Benefit Rule.Under ERISA, the requirement that Plan Assets be used for the exclusive purpose of providing benefits to plan Participants and Beneficiaries and defraying the reasonable expenses of administering the plan.
Exhaustion of administrative remedies.An ERISA procedure in which an individual must be given a reasonable opportunity for a full and fair review of a denied claim by the plan fiduciary, and the individual has followed and completed the procedure.
Exhaustion of COBRA continuation coverage. When an individual's COBRA continuation coverage ceases for any reason other than either failure of the individual to pay premiums on a timely basis, or for cause.
Experience rating.A method of setting insurance rates based on the claims history of the insured group.
Explanation of Benefits (EOB).A statement from a plan explaining what portion of a claim was paid.
Extra-contractual damages. A broad reference to either or both consequential and punitive damages.
F
Family and Medical Leave Act of 1993 (FMLA).A federal law that requires employers with more than 50 employees to provide up to 12 weeks of unpaid leave to employees.
Family coverage. Employer-provided health insurance that covers an employee or qualified beneficiary plus one or more dependents.
Federal government plan.A governmental plan established or maintained for its employees by the U.S. government.
Federal Register (Fed. Reg.). The federal government's official daily publication for regulations, proposed regulations, federal agency notices and other documents.
Federal Trade Commission.One of the federal agencies charged with overseeing the Gramm Leach-Bliley Act.
Fee-for-service.A billing method in which a health care provider charges separately for each service given and the payer reimburses without regard to provider affiliation.
FICA Taxes.Taxes collected for Social Security and Medicare benefits. (FICA refers to the Federal Insurance Contributions Act.) Cat
Fiduciary.Under ERISA, a person who has discretionary authority or control over the management of an Employee Benefit Plan, has any authority or control respecting management or disposition of Plan Assets, renders investment advice for a fee, or has discretionary authority or responsibility in the administration of the plan.
Financial Accounting Standards Board (F ASB). The independent, private authority for establishing accounting principles in the United States.
Firewall. Under HIPAA, certain protections that must be in place in order for a Group Health Plan to release Protected Health Information (beyond summary health information and/or enrollment/ disenrollment information) to a plan sponsor.
First day of coverage.In the case of an individual covered for benefits under a group health plan, the first day of coverage under the plan, and in the case of an individual covered by health insurance in the individual market, the first day of coverage under the policy.
Flexible Spending Arrangement (FSA). A reimbursement plan (including a Health FSA) or DCAP that gives employees coverage under which eligible expenses may be reimbursed, subject to certain conditions such as a maximum limit. The most common FSA is one offered through a Cafeteria Plan, with employees paying the entire premium for coverage through pre-tax dollars.
FMLA. The federal Family and Medical Leave Act of ] 993, which allows eligible employees of covered employers to take up to ] 2 weeks of certain unpaid, job-protected family and medical leave each year, and which requires employers to continue to provide certain benefits during the leave.
Forfeitures. Unused contributions remaining under a DCAP or Health FSA as of the end of a Plan Year (after any Run-Out Period), which, under the Use-It-or-Lose-It Rule, must be "forfeited."
Form 5500.The form for the Annual Report required to be filed for various employee benefit plans.
Funded Plan. Generally, a plan that has Plan Assets (except that certain Welfare Plans holding Participant Contributions are treated as Unfunded Plans for certain compliance purposes).
FUTA Taxes.Taxes collected for federal unemployment purposes. (FUTA refers to the Federal Unemployment Tax Act.)
G
Governmental Plan.A plan established or maintained by the government of the United States, the government of any state or political subdivision of the state, or any agency or instrumentality of these governments. Special rules apply to Governmental Plans.
Gramm-Leach-Bliley Act. A federal law requiring most banks, insurers, and other "financial institutions" to safeguard financial information and to provide privacy notices to their customers.
Group health insurance coverage.Health insurance coverage offered in connection with a group health plan.
Group Health Plan.Generally, a plan maintained by an employer or an employee organization that provides medical care to employees or their dependents. directly or through insurance, reimbursement. or otherwise. The specific definition differs depending on the federal statute at issue.
Group market.The market for health insurance coverage offered in connection with a group health plan.
Group Term Life Insurance (GTL). Life insurance provided to a group of employees that meets the requirements set forth in Code § 79.
Guaranteed availability. Generally, a requirement under which a health insurance issuer may not decline to offer coverage or deny enrollment.
Guaranteed renewability. A requirement under which a health insurance issuer must renew or continue coverage at the option of the individual.
H
HCFA. The Health Care Financing Administration. an agency of HHS. HCFA is now known as the Centers for Medicare and Medicaid Services (CMS). Now known as the EBSA
Health benefits.Generally includes health insurance, medical leave, health related tests and services, fitness and wellness programs. Dental and vision plans are also included, but to a limited extent under HIPAA.
Health Care Clearinghouse.An entity that processes or facilitates the processing of Health Information received from another entity in a nonstandard format or containing non-standard data into standard data elements or a standard transaction, or vice versa.
Health care component. A component of a covered entity that performs covered functions, and may include components that perform business associate functions.
Health Care Financing Administration (HCFA). See Centers for Medicare and Medicaid Services.
Health care operations.A covered entity's activities related to covered functions, and activities of a health care arrangement in which the covered entity participates.
Health care provider. A provider of medical or other health services, and any other person furnishing health care services or supplies.
Health Coverage Tax Credit (HCTC). A federal income tax credit for up to 65% of the premiums for COBRA coverage (or other qualified health insurance coverage) for an eligible individual and his or her qualifying family members.
Health FSA. A Flexible Spending Arrangement under which Participants may obtain reimbursement for medical expenses that cannot be reimbursed through insurance or any other arrangement (e.g., Co-Payments, Deductibles, eyeglasses, orthodontia).
Health information.Defined by HIPAA as any information, whether oral or recorded in any form or medium, that: (I) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and (2) relates to an individual's medical condition (be it past, present or future), health care or payment for health care.
Health insurance coverage. Benefits consisting of medical care (provided directly, through insurance or reimbursement or otherwise) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or HMO contract offered by a health insurance issuer.
Health Insurance Issuer. An insurance company. insurance service. or insurance organization (including an HMO) that is licensed to engage in the insurance business in a state and is subject to state insurance law.
Health Maintenance Organization (HMO). A type of health plan under which an organization assumes the responsibility for providing health care in a particular geographic area to covered persons and also assumes the financial risks associated with providing such care, usually in return for a set fee. Financial risk may be shared with the providers participating in the HMO.
Health Reimbursement Arrangement (HRA). An arrangement under which an employer promises to reimburse eligible employees for certain medical expenses up to a specified maximum amount per year and that meets the safe harbor requirements contained in IRS Notice 2002-45.
Health Savings Account (HSA).An account established by an eligible individual covered by a High Deductible Health Plan that meets the requirements of Code § 223 and enables the account-holder to pay for qualified medical expenses on a tax-favored basis.
Health status-related factor. Defined by HIPAA as a medical condition (including both physical and mental i11nesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of domestic violence) and disability.
HHS. The U.S. Department of Health and Human Services.
High Deductible Health Plan (HDHP). A health plan with a high deductible that meets prescribed requirements and a cap on out-of-pocket expenses that does not exceed a prescribed amount. Code § 223 (for HSAs) and Code § 220 (for Archer MSAs) each have a different definition of the term HDHP.
High-deductible health plan (HDHP). A health plan with an annual deductible exceeding specified thresholds, which must be offered in conjunction with an HSA or MSA.
Highly Compensated Employee (HCE).Generally, an employee for whom undue favor ( Le., discrimination) is prohibited under provisions of the Code that apply to Cafeteria Plans, self-insured Medical Reimbursement Plans, DCAPs, and certain other benefit plans. The specific definition differs, depending on the type of plan and the nondiscrimination requirement at issue.
HIPAA. The federal Health Insurance Portability and Accountability Act, which is far-reaching legislation designed to improve the portability of health coverage, reduce health care costs by standardizing the processing of health care transactions, increase the security and privacy of health care information, and to make other changes to the health care delivery system.
HRA.See Health Reimbursement Arrangement (HRA).
HSA. See Health Savings Account (HSA).
Hybrid entity. A voluntary designation for a single covered entity that performs both covered and non-covered functions. A covered entity may designate itself a hybrid entity to avoid the imposition of the privacy rules on its non-health care-related functions.
I
Indemnification. An arrangement under which one party agrees to payor reimburse another party for certain costs, damages, or expenses.
Indemnity plan. The "traditional" group health insurance arrangement under which the health plan agrees to reimburse the plan participant for specific health services. The plan can make the payment to the participant or directly to the health care provider.
Individual health insurance coverage.Health insurance coverage offered to individuals in the individual market. This does not include short-term, limited duration insurance.
Individual market. The market for health insurance coverage offered to an individual other than in connection with a group health plan. Unless a state elects otherwise in accordance with the PHSA, such term also includes coverage offered in connection with a group health plan that has fewer than two participants as current employees on the first day of the plan year.
Individually Identifiable Health Information.Under HIPAA, Health Information that identifies the individual to whom it relates (or offers a reasonable basis for identification) and is created or received by a health plan (as defined in IDPAA), health care provider, Health Care Clearinghouse, or employer.
Insured plan. A group health plan, the benefits of which are normally provided by an insurer other than the employer.
Internal Revenue Code. See Code.
International Foundation of Employee Benefit Plans (IFEBP). A membership association based in Brookfield, Wis., that consists of individuals involved or interested in the field of employee benefit plans.
“IRC” or “Code.” The Internal Revenue Code.
K
Key Employee. Certain employees who are officers or owners of the employer (as further defined in Code § 416) and for whom undue favor (i.e., discrimination) is prohibited under provisions of the Code that apply to Cafeteria Plans and certain other benefit plans.
L
Large employer.Under HIPAA, in connection with a group health plan, an employer that employed an average of at least 51 employees on business days during the preceding calendar year and that employs at least two employees on the first day of the plan year.
Large group market. The health insurance market under which individuals obtain health insurance coverage (directly or through any arrangement) on behalf of themselves (and their dependents) through a group health plan maintained by a large employer, unless otherwise provided under state law.
Late Enrollee. Under HIPAA, an individual who enrolls in a Group Health Plan after the first available enrollment period, other than an individual who is a Special Enrollee.
Late enrollment.Enrollment under a group health plan other than on: (1) the earliest date on which coverage can become effective under the plan terms; or (2) a special enrollment date for the individual.
Leased Employee.Under the Code, a worker who provides services pursuant to an agreement between the recipient of the services and a Leasing Organization if the worker has performed such services for the recipient on a substantially full-time basis for at least one year and the services are performed under primary direction or control by the recipient (as defined in Code § 414(n)).
Leasing Organization. An organization (such as a "temp agency" or PEO) that contracts with client organizations to provide workers.
Leave of absence. Any temporary absence from employment authorized by the employer based on its normal practices.
Legal separation. A process in which a husband and wife are required to live apart from each other by the terms of a decree of separate maintenance.
Limited data set. A set of PHI for specific restricted uses that is not fully de-identified but excludes certain direct identifiers.
Limited-scope excepted benefits. Limited-scope dental and vision benefits, and long-term care benefits, that are excepted from HIPAA's portability rules because they are provided under a separate rider or contract, or are not an integral part of the plan.
Long-term care. Health and custodial care provided both in institutional and noninstitutional settings to people with debilitating chronic health and mental conditions that prohibit them from taking care of themselves.
Long-Term Disability (LTD) Plan.A plan that provides income-replacement benefits to employees or former employees unable to work due to disability.
Look-Back Rule.Under HIPAA, a rule limiting the application of Preexisting Condition Exclusions to conditions for which medical advice, diagnosis, care, or treatment was recommended or received
M
Major medical insurance. Health insurance to finance the expense of long-term, chronic or catastrophic illness. Covers inpatient and outpatient care, including the costs of X-ray treatment, tests, medicine, home and office medical care, psychiatric care and the services of a private nurse.
Managed care. An approach to controlling utilization, quality and cost of medical care using a variety of cost-containment methods, usually on a capitated basis, with an emphasis on creating incentives for employees to choose less expensive treatments and disincentives for employees to choose more expensive ones.
Material Modification. Under ERISA, a material change in the terms of a plan or any change in the information required to be in the SPD, requiring the issuance of a Summary of Material Modifications. See also Material Reduction in Covered Services or Benefits.
Maximum Coverage Period. Under COBRA, the maximum period for which COBRA Coverage must be offered for a particular Qualifying Event.
Medicaid. A program sponsored by the federal and state governments that pays for medical services for lower-income individuals.
Medical care. Amounts paid for any of the following: (I) the diagnosis, cure, mitigation or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body; (2) transportation primarily for and essential to medical care; and (3) insurance covering medical care.
Medical child support order. A domestic relations judgment, decree or order issued by a court that requires a parent to provide family coverage to a child. It can also enforce certain state medical child support laws.
Medical condition.Any condition, whether physical or mental, including, but not limited to, any condition resulting from illness, injury (whether or not the injury is accidental), pregnancy or congenital malformation. However, genetic information is not a medical condition.
Medical Reimbursement Plan. A self-insured employer-sponsored plan designed to reimburse employees and their families for their medical expenses. A medical reimbursement plan may be a broad-based Self-Insured Plan that provides coverage comparable to that under an insured Indemnity Plan or may be very limited in scope (for instance, it may reimburse only dental expenses up to $1,000 per year). Medical reimbursement plans that are Flexible Spending Arrangements are called Health FSAs.
Medical savings account. Under HIPAA, a trust created or organized exclusively to pay the qualified medical expenses of the account holder offered in conjunction with a high deductible health plan.
Medical spending accounts. A version of flexible spending accounts funded by employee salary reductions and/or employer contributions that allows employees to set aside money on a pre-tax basis for specific health care expenses that are not covered by the medical plan.
Medicare Secondary Payer (MSP).Federal law making Medicare the secondary payer in most situations in which other coverage exists.
Medicare. A program sponsored by the federal government to pay for certain medical expenses for qualified individuals - primarily those age 65 and over and the disabled. The program includes three separate but coordinated programs: Hospital insurance (Part A), supplementary medical insurance (Part B) and Medicare Choice (Part C). Also see Entitlement, Medicare.
Mental health benefits.Under the Mental Health Parity Act, benefits regarding mental health services, as defined under the terms of the plan, that do not include benefits for treatment of substance abuse or chemical dependency.
MHPA. The federal Mental Health Parity Act, which prohibits a Group Health Plan from applying a lower annual or aggregate lifetime dollar limit to mental health benefits than it applies to medical/surgical benefits.
Minimum Necessary Standard.The requirement, under HIPAA, that a Covered Entity make reasonable efforts to limit the Protected Health Information (PHI) that it uses, discloses or requests from another Covered Entity to the minimum necessary to accomplish the intended purpose of the use, disclosure or request.
Multiemployer Plan. A plan maintained pursuant to one or more collective bargaining agreements, under which more than one employer contributes to the plan on behalf of its employees.
Multiple employer trust (MET). Multiple employer arrangements that are sponsored by insurance companies and usually organized as trusts.
Multiple employer welfare arrangement (MEWA). An arrangement between or among two or more unrelated employers that is not maintained pursuant to a collective bargaining agreement. These types of arrangements can be useful to employers that want to protect themselves from being penalized for the actions of other employers participating in a multiple-employer group.
N
NAIC. The National Association of Insurance Commissioners.
National Medical Support Notice. A standardized medical child support order that is used by state child support enforcement agencies to obtain coverage for children under Group Health Plans.
Network plan. Health insurance coverage of a health insurance issuer under which the financing and delivery of medical care (including items and services paid for as medical care) are provided, wholly or in part, through a defined set of providers under contract with the issuer.
NMHPA. The federal Newborns' and Mothers' Health Protection Act, which requires that Group Health Plans that provide benefits for hospital lengths of stay in connection with childbirth for a mother or newborn child may not restrict benefits for such stays to less than 48 hours following a vaginal delivery or to less than 96 hours following a cesarean section.
Noncompliance. Failure to follow the rules set forth by legislation and/or regulations.
Non-Confinement Clause. A provision that delays eligibility for dependents who are confined in a hospital at the time their Group Health Plan coverage would otherwise begin. An Actively-at- Work Clause is a related provision.
Nondiscrimination Rules. Under HIPAA, rules that prohibit a Group Health Plan from discriminating with regard to eligibility, premiums or contributions based on specified health status-related factors, such as medical condition or history, disability or genetic information. Under the Code, rules that prohibit a plan from discriminating in favor of Highly Compensated Employees ( HCEs) or Key Employees.
Notice of information practices. A notice that describes the PHI uses and disclosures that a covered entity may make, an individual's rights and a covered entity's responsibilities. Also called a notice of privacy practices.
Notice of Privacy Practices.Under HIPAA, a notice describing a Covered Entity s privacy practices for PHI, including the uses and disclosures of PHI that may be made by the Covered Entity, individuals' rights with respect to their PHI, and the Covered Entity siegal duties with respect to the PHI.
O
OCR. The Office of Civil Rights. OCR is an agency of HHS. Open Enrollment An annual period, usually occurring shortly before the beginning of a new Plan Year, during which employees can enroll for benefits and change their elections under the employer's plans.
Open enrollment period. A period during which individuals are allowed to enroll in a plan or change certain elements of their insurance coverage and other benefits.
Opt-Out Procedure. The procedure under which non-federal, Self-Insured Governmental Plans may elect not to be subject to any of HIPAA s Portability Requirements, except the Certificate of Creditable Coverage requirements. Similar opt-out provisions exist under the MHPA, NMHPA, and WHCRA.
Organized health care arrangement. An arrangement in which legally separate companies must share PHI in order to manage benefits for an integrated and jointly managed health care system. Also includes two or more group health plans maintained by the same plan sponsor.
Out-or-Pocket Medical Expenses. Co-payments, deductibles, and medical expenses that are not covered by the employer's major medical plan.
Over-the-Counter (OTC) Drug or Medicine. A drug or medicine that is sold lawfully without a prescription.
P
Participant Contributions. Amounts (other than union dues) that a Participant or Beneficiary pays to an employer, or amounts that a Participant has withheld from his or her wages by an employer, for contribution to a plan. The term. includes wage withholdings, salary reductions, COBRA premiums, and retiree premiums.
Participant. Any employee or former employee of an employer, or any member or former member of an employee organization, who is or may become eligible to receive a benefit of any type from an employee benefit plan which covers employees of employers or employee organizations, or whose beneficiaries may be eligible to receive any such benefit.
Party - In-Interest. Under ERISA's Prohibited Transaction rules applicable to Employee Benefit Plans, a person or entity that has a direct relationship to the plan (for example, an administrator or service provider) or that has a relationship with such person or entity.
PDA. The federal Pregnancy Discrimination Act, which prohibits covered employers from discriminating against an employee due to pregnancy, childbirth or related medical conditions.
Personal Representative. Under HIPAA, an individual who is permitted under applicable law to act on another individual's behalf in making decisions related to health care.
PHI. See Protected Health Information.
PHSA. The federal Public Health Service Act, which contains the provisions of COBRA that govern continuation coverage under government-sponsored Group Health Plans, as well as certain provisions of HIPAA and other federal group health plan mandates.
Physical Safeguards.Under the security provisions of HIPAA's Administrative Simplification rules, physical measures, policies, and procedures to protect a Covered Entity's electronic information systems and related buildings and equipment from natural and environmental hazards and unauthorized intrusion.
Placement, or being placed, for adoption. The assumption and retention of a legal obligation for total or partial support of a child by a person with whom the child has been placed in anticipation of the child's adoption.
Plan Administrator. Under ERISA, the person or entity designated to act as Plan Administrator in the plan's governing documents. If no Plan Administrator is designated, then the Plan Sponsor is the Plan Administrator. The Plan Administrator is responsible for many of the statutory duties imposed by ERISA. The Plan Administrator is commonly the sponsoring employer or a committee.
Plan Assets. Funds or property of a plan, including Participant Contributions.
Plan document. Explains a plan's provisions, usually including the benefits that it provides and the rights of those whom it covers.
Plan limits. Any of the various limits imposed by a plan, such as the amount of deductibles or out-of-pocket expenses that must be paid by covered members, or the maximum benefits that can be paid under a plan.
Plan Sponsor. Under ERISA, the plan sponsor of a single employer plan is the employer that maintains the plan. The plan sponsor may be different when other types of plans are involved (e.g., Multiemployer Plans or MEWAs).
Plan Year. The l2-month period on which a plan's records are maintained. The period must be described in the Summary Plan Description.
Point-of-service (POS) plan. An arrangement under which a primary care physician is the first point of contact and directs individuals to specialists when required.
Portability Requirements. HIPAA's provisions regarding Preexisting Condition Exclusions, Special Enrollment, and Nondiscrimination Rules.
Preemption. A legal rule. based on the supremacy clause of the U.S. Constitution, under which state laws can be preempted (i.e., blocked from enforcement) by federal law. ERISA contains a complicated express preemption provision. HIPAA and some other federal group health plan mandates also contain preemption rules.
Pre-existing condition exclusion. Under HIP AA, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the first day of coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before that day. This includes any exclusion applicable to an individual as a result of information that is obtained regarding an individual's health status before his or her first day of coverage.
Pre-existing condition limitation period. Under HIP AA, a pre-existing condition limitation period cannot exceed 12 months (or 18 months for certain individuals who enroll late).
Preexisting Condition. A condition (physical or mental) that existed before the individual's effective date of coverage under a plan. HIPAA regulates the definition of Preexisting Condition that must be used by all Group Health Plans.
Preferred Provider Organization (PPO) Plan. A type of Indemnity Plan under which health coverage is provided through a specified network of health care providers (e.g .. hospitals and physicians). Covered persons who obtain care from providers outside the network generally incur greater costs (e.g., higher Deductibles, higher Co-Insurance rates. or nondiscounted provider charges).
Preferred provider organization (PPO). A group of hospitals or physicians that contracts with employers, insurance plans or third-party administrators to provide health care.
Premium Conversion Plan.See Premium Payment Plan.
Premium Payment Plan.The most common form of Cafeteria Plan, which has only one objective: to permit employees to pay for their share of the premiums for certain insurance coverages (e.g .. group health coverage) with pre-tax dollars.
Premium. The predetermined amount paid by the plan participant to the insurance company to indemnify the plan participant against loss. Premiums may be made in a single payment or a series of payments.
Premium-Only Plan (POP). See Premium Payment Plan.
Pre-Tax Contributions.Contributions that are made pursuant to an employee's written agreement to reduce his or her salary on a pre-tax basis (i.e .. before the compensation has been taxed). to pay for certain elected benefits.
Privacy Official. Under HIPAA, an individual designated by a Covered Entity to be responsible for the development and implementation of privacy policies and procedures.
Private letter ruling. An opinion letter issued by the IRS in response to specific questions and factual situations presented by individuals. While private letter rulings can be relied upon as authoritative rulings only by the individuals to whom it is issued, they are often cited by other individuals, since they may indicate the IRS's position on a particular issue.
Professional Employer Organization (PEO). An organization that contracts with client organizations to provide workers, payroll, and other services.
Prohibited Transaction Exemption. An exemption from ERISA s Prohibited Transaction provisions. ERISA contains several statutory exemptions. In addition. the DOL is authorized to grant individual and class exemptions from ERISA s Prohibited Transaction provisions.
Prohibited Transaction. A transaction between a Party-in-Interest and an Employee Benefit Plan or action by a Fiduciary that is prohibited under ERISA (even if it is fair or beneficial to the plan), unless an exemption exists.
Protected Health Information (PHI).Under IDPAA, Individually Identifiable Health Information that is maintained or transmitted in any form or medium by a Covered Entity or its Business Associate, as further defined in 45 CFR § 160.103.
“Prudent man” rule. Under ERISA, plan fiduciaries are required to carry out their duties with the care, skill, prudence and diligence that a prudent man would use in a similar situation.
Psychotherapy notes. Notes recorded in any medium by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint or family counseling session.
Public health plan.Any plan established or maintained by a state, county or other political subdivision of a state that provides health insurance coverage to individuals who are enrolled in the plan.
Public Health Service Act (PHSA). The federal statute that regulates the health plans of state and local governments.
Q
QMCSO. See Qualified Medical Child Support Order.
Qualified Beneficiary. Under COBRA, an individual who must in certain circumstances be offered the opportunity to elect COBRA Coverage under a Group Health Plan. The term generally includes a Covered Employee's spouse or dependent children who were covered under the Group Health Plan on the day before a Qualifying Event, as well as a Covered Employee who was covered under the Group Health Plan on the day before a Qualifying Event that is a termination of employment or reduction in hours. The term also includes a child born to or adopted by a Covered Employee during a period of COBRA coverage.
Qualified Benefits. Benefits that may be offered under a Cafeteria Plan. Examples include coverage under an accident or health plan, benefits under a Health FSA or DCAP, and Group Term Life Insurance plan coverage.
Qualified Domestic Relations Order (QDRO). A court order that assigns to an "alternate payee" (generally, a Participant s former spouse) the right to receive a portion of the Participant s benefits and meets additional requirements specified in the Code and ERISA.
Qualified Medical Child Support Order (QMCSO). A judgment, decree, or order (issued by a court or through a state administrative process) that requires a Group Health Plan to provide coverage to a Participant's child and meets other specific requirements. A QMCSO typically requires the Group Health Plan of a child's non-custodial parent to provide coverage to the child, even though the child may not be a "dependent" under the plan's definition.
Qualified medical expenses.Regarding a holder of a medical savings account, amounts paid for medical care for the individual, his or her spouse, and any dependent, but only to the extent such amounts are not compensated for by insurance or otherwise.
Qualified plan. See Qualified benefit.
Qualified Transportation Fringe Benefit Plan. A plan that meets the requirements of Code § 132(f)(4) and allows an employer to provide certain transportation fringe benefits, including transit passes, vanpooling, and parking, on a tax-free basis.
Qualifying event. Under COBRA, any of the following events that causes a loss of coverage: (1) termination of employment or reduction in hours of employment; (2) death of a covered employee; (3) divorce or legal separation; (4) a covered employee's entitlement to Medicare; (5) a dependent child's loss of dependent status; or (6) loss of coverage due to the employer's filing of a bankruptcy proceeding.
Qualifying Individual. An individual whose dependent care expenses may be submitted by an employee for reimbursement under a DCAP or may allow a taxpayer to claim the Dependent Care Tax Credit. The term includes certain children under age 13, as well as certain individuals who are physically or mentally incapable of self-care, as further defined in Code § 21.
R
Reasonable and customary (R&C) charges.A term used in many health plans, defined as the price at or below which the majority of health-care professionals of similar expertise charge for similar procedures within a specific geographic area.
Revenue rulings. Conclusions of the IRS on the application of the law to particular factual situations.
S
Salary Reduction Plan.A type of Cafeteria Plan under which employees may choose to receive their full salary in cash, or to have their salary reduced on a pre-tax basis and applied by their employer to purchase some or all of the Qualified Benefits that the plan offers (e.g., health insurance).
Salary reduction. A method of having employees contribute to the cost of their benefits by deducting their contributions from their gross (pre-tax) compensation. Under the tax code, salary reductions are counted as employer contributions because the employee never possesses them.
Security Incident.Under HIPAA's Administrative Simplification rules, the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system.
Self-Insured Plan. A plan that does not use insurance to pay benefits. (However, the plan or its sponsor may purchase Stop-Loss Insurance.)
Significant break in coverage.Defined by HIPAA as a period of 63 consecutive days during all of which an individual does not have any creditable coverage, except that neither a waiting period nor an affiliation period is taken into account in determining a significant break in coverage.
Single coverage.Insurance coverage that covers only the person named in the policy.
Six-month look-back period. Under HIPAA, a pre-existing condition exclusion must relate to a condition (whether physical or mental) regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within the six-month period ending on the enrollment date.
Small employer.Under HIPAA, in connection with a group health plan with respect to a calendar year and plan year, an employer that employed an average of at least two but not more than 50 employees on business days during the preceding calendar year and that employs at least two employees on the first day of the plan year, unless otherwise provided under state law.
Small Group Market. Generally, the market for group health insurance coverage for employers with between 2 and 50 employees.
Small health plan. A health plan with annual receipts of $5 million or less. In calculating receipts, insured plans should use total premiums and self-insured plans should use the total amount paid for claims. Small health plans have an extra year to comply with HIPAA's privacy and EDI rules.
SMM. See Summary of Material Modifications.
Social Security Administration (SSA). The federal agency that administers retirement insurance and disability payments under the U.S. Social Security program.
SPD. See Summary Plan Description.
Special Enrollee. An individual who enrolls in a Group Health Plan pursuant to Special Enrollment rights conferred by HIPAA.
Special enrollment date.Under HIPAA, generally any date on which an individual's right to enroll in a group health plan becomes effective.
Special enrollment period.Defined by HIP AA as a period of time in which employers must enroll individuals who: (1) did not enroll in an employer's group health plan when they were first eligible due to the existence of alternative coverage; or (2) incur certain events such as marriage, birth, adoption or placement for adoption.
Stop-Loss Insurance. Insurance purchased by a Self-Funded Plan or its sponsor to protect against higher-than-expected claims experience. Under the typical stop-loss policy, the insurer agrees to reimburse the employer or plan for individual and/or aggregate claims paid in excess of a specified amount. Also called "excess loss coverage" or "re-insurance."
Subrogation. The right of a plan or its insurer to be put in the position of a Participant or Beneficiary in order to recover from third parties that are legally responsible to him or her for a loss paid under the plan.
Summary Annual Report (SAR).Under ERISA, a summary of an Employee Benefit Plan's Form 5500 filing that must be furnished, subject to certain exceptions, to covered Participants and certain other individuals.
Summary health information. Individually identifiable health information that includes claims history, claims experience or the type of claims experienced by individuals in the group health plan; and has removed all identifiers that must be removed for the information to be "de-identified," with one exception.
Summary of Material Modifications (SMM).Under ERISA, a summary of plan or SPD changes that must be distributed to covered Participants and certain other individuals when there is a Material Modification to the plan or a change in the information required to be in the SPD.
Summary Plan Description (SPD). Under ERISA, a summary of an Employee Benefit Plans terms that must be furnished, subject to very limited exceptions, to covered Participants and certain other individuals. ERISA
Supplemental benefits. Benefits such as Medicare supplemental health insurance, CHAMPUS supplemental programs and similar supplemental coverage provided under a group health plan.
T
Technical Safeguards. Under the security provisions of HIPAA's Administrative Simplification rules, the technology, and the policies and procedures for its use, that protect Electronic PHI and control access to it.
Third-Party Administrator (TPA). An outside entity that handles certain plan administrative responsibilities for the employer or other designated Plan Administrator. Typically, a contract with the TPA determines the amount of control the TPA exercises over the plan.
Third-party payer. A public or private organization that pays for or underwrites coverage for health care expenses of another entity, usually an employer.
Title VII of the Civil Rights Act. A federal law that prohibits a covered employer from discriminating against an individual with respect to compensation, terms, conditions, or privileges of employment on the basis of the individual's race, color, religion, sex or national origin.
Total disability. An illness or injury that prevents an employee from performing his or her job or any job for which he or she is qualified by training, education or experience.
Trading partner agreement. Relates to the exchange of information in electronic transactions, whether the agreement is distinct or part of a larger agreement.
Treatment. The provision. coordination or management of health care and related services by one or more health care providers.
TRICARE. Provides health coverage for the families of members of the armed services, including the families of reservists called for active duty. Formerly known as CHAMPUS.
Trust. A legal entity that holds funds or property for the benefit of a plan's Participants and Beneficiaries.
Trustee. A person or entity that manages and controls a Trust, with Fiduciary responsibility to maintain the Trust for the benefit of the plan's Participants and Beneficiaries.
U
Underwriting. The assessment of the risk of providing coverage to an individual or group.
Unfunded Plan. A plan that pays benefits solely from the employer's general assets and not through insurance or Plan Assets (except that certain Welfare Plans holding Participant Contributions are treated as Unfunded Plans for certain ERISA compliance purposes).
Use-It-or-Lose-It Rule.Under the Code, a requirement applicable to Cafeteria Plans under which employees cannot be pennitted to carry over unused contributions from one Plan Year to another.
USERRA. The federal Uniformed Services Employment and Reemployment Rights Act, which requires employers to provide certain reemployment and benefit rights to employees who take a leave of absence for service in the uniformed services.
V
Voluntary employees' beneficiary association (VEBA). A trust deriving its tax exemption under Internal Revenue Code Section 501(c)(9) that is created to fund life insurance, sick leave, health care, accident insurance or certain other benefits for a nondiscriminatory class of employees, their dependents or their designated beneficiaries.
Voluntary Plans. Also called employee-pay-all plans, these are insured arrangements that may be exempt from ERISA if there is minimal employer involvement and no employer contributions.
W
Waiting period. The period that must pass before an employee or dependent is eligible to enroll under the terms of a group health plan.
Welfare Plan. Under ERISA, a plan, fund, or program established by an employer, by an employee organization, or by both (other than certain church and governmental plans), for the purpose of providing Participants or their Beneficiaries, through insurance or otherwise, medical, surgical or hospital care or benefits; benefits in the event of sickness, accident, disability, death or unemployment; vacation benefits; apprenticeship or other training benefits, daycare centers, scholarship funds; pre-paid legal services; holiday and severance benefits or housing assistance benefits.
Wellness program. A program designed to promote a healthy lifestyle among employees through exercise facilities and classes or seminars on nutrition, exercise and health education.
WHCRA. The federal Women's Health and Cancer Rights Act, which requires Group Health Plans that provide mastectomy benefits to provide coverage for reconstructive surgery and certain other related benefits.
Workers' compensation. A benefit in which an employer provides cash payments or medical care to employees who are injured on the job. These benefits are mandated by state law and include partial wage replacement benefits and rehabilitation benefits.