Accident insurance: A supplemental insurance that pays you a lump sum if you're injured or undergo specific medical treatments due to a covered accident. The funds can be used however you need, including to help cover deductibles, copayments, or other out-of-pocket costs not covered by your medical plan.
Coinsurance: The percentage of costs you share with your insurance carrier after you've met your deductible. For example, with 80/20 coinsurance, your insurance pays 80% and you pay 20% of covered expenses.
Copay: A fixed dollar amount you pay for a specific medical service, like a primary care visit or prescription. Copays are typically due at the time of service.
Critical illness insurance: A supplemental insurance that provides a lump sum payment if you're diagnosed with a serious illness covered by the policy, such as cancer, heart attack, or stroke. The payment can help cover expenses not typically covered by standard health insurance, like lost income or transportation costs.
Deductible (Individual and Family): The amount you pay out of pocket for covered healthcare services before your insurance begins sharing costs.
The individual deductible applies to each person on your plan. Once one person hits their limit, insurance kicks in for them.
The family deductible is a combined cap for everyone on your plan. Once your family reaches it together, insurance kicks in for the whole family.
Example: With a $1,500 individual / $3,000 family deductible, a single family member's costs are capped at $1,500 — but no matter what, your family won't pay more than $3,000 combined before insurance steps in.
Dental insurance: Coverage that helps pay for dental care, from routine cleanings and x-rays to more complex procedures like root canals and orthodontics.
FSA (Flexible Spending Account): A tax-advantaged account that lets you set aside pre-tax money for qualified medical expenses. FSA funds are set up through your employer and typically need to be used within the plan year, though some employers offer a grace period or small rollover.
HDHP (High-Deductible Health Plan): A health insurance plan with lower monthly premiums and higher deductibles than traditional plans. HDHPs are often paired with an HSA, allowing you to save pre-tax money for healthcare costs.
Hospital indemnity insurance: A supplemental insurance that provides a fixed cash benefit for each day you're hospitalized for a covered reason. It helps offset expenses not covered by your medical plan, like childcare or transportation during a hospital stay.
HRA (Health Reimbursement Arrangement): An account funded entirely by your employer that reimburses you for qualified medical expenses. You don't contribute to an HRA yourself. Your employer sets the rules on what it covers and how much is available each year.
HSA (Health Savings Account): A tax-advantaged account that lets you set aside pre-tax money for qualified healthcare expenses. To contribute to an HSA, you must be enrolled in an HDHP. The funds roll over year to year, grow tax-free, and you own the account even if you change jobs.
Identity and fraud protection: Coverage that provides assistance and financial protection if you experience identity theft, including help with legal fees, lost wages, and recovery costs.
In-network: Providers, hospitals, and facilities that have agreed to provide services at negotiated rates for members of a specific insurance plan. Staying in-network typically means lower out-of-pocket costs for you.
Legal plan: A benefit that covers some or all of the costs of legal advice and representation for a variety of issues, such as estate planning, family law, or traffic violations.
Life insurance: Coverage that provides a financial benefit to your beneficiaries in the event of your death, helping cover expenses like household needs, debts, and funeral costs.
Long-term disability insurance (LTD): Insurance that replaces a portion of your income if you're unable to work for an extended period due to a serious illness or injury. LTD benefits typically begin after short-term disability benefits end and can last for several years or until retirement age.
Open Enrollment: The period each year when you can sign up for, change, or waive your employer-sponsored benefits. Outside of Open Enrollment, changes are generally only allowed after a Qualifying Life Event (QLE).
Out-of-pocket maximum: The most you'll pay for covered healthcare services in a plan year. Once you reach your out-of-pocket maximum, your insurance covers 100% of covered expenses for the remainder of the year.
Pet insurance: Coverage that helps pay for veterinary care for your pets, including accidents, illnesses, and in some cases preventive care.
Premium: The amount you pay each month for your health insurance coverage, typically deducted from your paycheck.
Qualifying Life Event (QLE): A change in your life circumstances such as getting married, having a child, or losing coverage that allows you to make changes to your benefits outside of Open Enrollment.
Short-term disability insurance (STD): Insurance that replaces a portion of your income if you're temporarily unable to work due to illness or injury. Coverage typically lasts between 12 weeks and one year.
Vision insurance: Coverage that helps pay for eye exams, prescription glasses, and contact lenses, reducing your overall eye care expenses.
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