We use a lot of industry specific terminology to explain what we do and how we do it. If you came across something unfamiliar, check out our glossary for clarification.
AAP – Affirmative Action Plan
AARP – American Association of Retired Persons
ACA – The Affordable Care Act is health care legislation passed by Congress and then signed into law on March 23, 2010 by President Obama. The law mandates changes to both the American Health System as well as key elements of health insurance coverage with specific requirements of employers based on their company size. The health care law, also known as the Patient Protection and Affordable Care Act, requires that all Americans have healthcare coverage by 2014. Some of the most notable developments of the ACA include the launch of a health insurance marketplace or exchange by the federal government and the requirement that no one be denied health insurance coverage due to pre-existing conditions.
ACRS – Accelerated Recovery Cost System
AD&D – Accidental Death & Dismemberment
ADA – The Americans with Disabilities Act of 1990
ADEA – Age Discrimination in Employment Act of 1967
Affiliation Period – A period of time that must pass before health insurance coverage provided by an HMO (Health Maintenance Organization) becomes effective. If a group health plan provides coverage to you through an HMO with an affiliation period, the affiliation period cannot be longer than 2 months (3 months for a late enrollee) from your enrollment date, and the plan cannot impose a pre-existing condition exclusion. During the affiliation period, the plan cannot charge you premiums, and the HMO is not required to provide benefits. The affiliation period must run concurrently with any waiting period for coverage under the plan.
AFL-CIO – American Federation of Labor – Congress of Industrial Organizations
AICPA – American Institute of Certified Public Accountants
Annual Dollar Limit – With respect to benefits under a group health plan or health insurance coverage, a dollar limitation on the total amount of benefits that may be paid with respect to such benefits in a 12-month period under the plan or health insurance coverage with respect to an individual or other coverage unit.
APR – Annual Percentage Rate
ARM – Adjustable Rate Mortgage
ASO – Administrative Services Organization
Attending Provider – An individual who is licensed under applicable State law to provide maternity or pediatric care and who is directly responsible for providing such care to a mother or newborn child. Therefore, a plan, hospital, managed care organization, or other issuer is not an attending provider. However, a nurse midwife or a physician assistant may be an attending provider if licensed in the State to provide maternity or pediatric care in connection with childbirth. Note: This definition only applies to the elaws section of the Newborns’ and Mothers’ Health Protection Act.
Benchmarking – Benchmarking is the process of comparing one’s business processes and performance metrics to industry bests or best practices from other companies.
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 there under.
CCRS – Capital Cost Recovery System
CD – Certificate of Deposit
CERCLA – Comprehensive Environmental Response, Compensation and Liability Act
Certificate of Creditable Coverage – A written certificate issued by a group health plan or health insurance issuer (including an HMO) that shows your prior health coverage (creditable coverage). A certificate must be issued automatically and free of charge when you lose coverage under a plan, when you are entitled to elect COBRA continuation coverage or when you lose COBRA continuation coverage. A certificate must also be provided free of charge upon request while you have health coverage or within 24 months after your coverage ends. The Department has developed a model certificate that can be used by a group health plan or a health insurance issuer. Correct use of the model will generally assure compliance with the regulatory requirements.
CFR – Code of Federal Regulations (http://www.gpoaccess.gov/cfr/index.html)
CHAMPUS – Civilian Health and Medical Program of the Uniformed Services
Church Plan – A plan established or maintained for its employees (or their beneficiaries) by a church or by a convention or association of churches which is exempted from tax under Section 501 of the Internal Revenue Code of 1954
Client employer – Client employer refers to a client of the PEO who is also an employer with active employees. A client employer may be regarded as the on-site employer or primary employer as well and typically has direct contact/control over the employee population.
Co-employment – Co-employment typically describes an arrangement where two or more organizations share or bear employment level responsibilities and duties over an employee. As an example, one of the employers may have direct supervisory control and responsibilities (hiring, training, scheduling, discipline, firing, etc.) whereas the other may carry the administrative responsibilities such as processing wages, filing and remittance of taxes, enrollment in benefit plans or coverage and processing of work-site injury claims. Co-employment arrangements can vary widely so there is typically a statement or explanation provided to employees outlining or defining the relationship at the time of hire or onboarding.
Co-pay – Coinsurance is a percentage payment after the deductible up to a certain limit. It must be paid before any policy benefit is payable by an insurance company. Copayments do not usually contribute towards any policy out-of-pocket maxima whereas coinsurance payments do.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) – COBRA is a federal law that provides rights to temporary continuation of group health plan coverage for certain employees, retirees and family members at group rates when coverage is lost due to certain qualifying events.
COBRA Continuation Coverage – The temporary continuation of group health plan coverage available after a qualifying event to certain employees, retirees and family members who are qualified beneficiaries. Those who are eligible may be required to pay for COBRA continuation coverage and are generally entitled to coverage for a limited period of time (from 18 months to 36 months), depending on certain circumstances.
CODA – Cash or Deferred Arrangement
COLA – Cost-of-living adjustment
COLI – Corporate Owned Life Insurance
Commuters (commuter benefits) – Employer-provided benefits that allow employees to reduce their monthly commuting expenses for transit, biking, vanpooling and parking.
Compliance – PEO Compliance may encompass any number of topics including but not limited to Payroll Administration, Tax Administration, Benefit Administration, Workers Comp Administration, and Human Resources/Employment Administration. Each of these areas typically has a nationally recognized or certified body of professional regulators which help define laws or guide employers or employment services organizations through local, state and/or federally imposed regulations such as Minimum Wage, Pre Tax and Post Tax benefits participation, Hiring and Firing of employees, Family and Medical leave, timely and accurate filing of taxes such as local, state and federal income tax, social security and medicare, federal unemployment and state unemployment as well as ensure businesses have valid workers compensation coverages in place to protect against accidents or injuries in the workplace.
Constructive Dollar Limit – Health plans can generally set the terms and conditions (such as cost-sharing and limits on the number of visits or days of coverage) for the amount, duration, and scope of mental health benefits. However, a plan may not impose a constructive dollar limit on mental health benefits that is lower than that for medical/surgical benefits. A limit on the number of visits coupled with a maximum dollar amount payable per visit by the plan is a constructive dollar limit.
Covered Employee – An individual who is (or was) provided coverage under a group health plan that is subject to COBRA because that individual was employed by one or more persons maintaining the group health plan.
CPI – Consumer Price Index
CPT – Current Procedural Terminology
CRA – Civil Rights Act of 1964 (Title VII) (http://www.eeoc.gov/laws/vii.html)
Creditable Coverage – Health coverage you have had in the past, such as coverage under a group health plan (including COBRA continuation coverage), an HMO, an individual health insurance policy, Medicare or Medicaid, and this prior coverage was not interrupted by a significant break in coverage. The time period of this prior coverage must be applied toward any pre-existing condition exclusion imposed by a new health plan. Proof of your creditable coverage may be shown by a certificate of creditable coverage or by other documents showing you had health coverage, such as a health insurance ID card.
Deductible – In an insurance policy, the deductible is the amount of expenses that must be paid out of pocket before an insurer will pay any expenses.
Dependants – A person who relies on another, especially a family member, for financial support.
DOJ – U.S. Department of Justice
DOL – U.S. Department of Labor
DOT – U.S. Department of the Treasury
DRA – Deficit Reduction Act of 1984
DRG – Diagnostic-related group
Drug Formulary – A list of all the medicines that will be covered by your group health plan.
E&P – Earnings and Profits
EAP – Employee Assistance Programs
ECU – European Currency Unit
EDGAR – Electronic data gathering, analysis and retrieval
EDP – Electronic data processing
EEO – Equal Employment Opportunity (see Affirmative Action)
EEOC – Equal Employment Opportunity Commission
EFTA – Electronic Fund Transfer Act (1978)
EFTS – Electronic funds transfer system
Elect – When referring to health coverage, this means to choose, generally in writing, to participate in a group health plan.
Election Notice – “Written notification to each qualified beneficiary of the qualified beneficiary’s rights to COBRA continuation coverage. This notice must include, among many other things, information about the plan, qualifying events, length of COBRA continuation coverage, and how much a qualified beneficiary must pay for coverage and when and to whom the payments are due. This notice should explain how long the qualified beneficiary will have to decide whether or not to elect COBRA continuation coverage. The group health plan must allow at least 60 days from the date of the notice, or from the date coverage ended, whichever is later, for a qualified beneficiary to elect COBRA continuation coverage. The Department of Labor has developed a model election notice that is intended to assist plan administrators of single-employer group health plans in satisfying the election notice requirement. Use of this model notice is not mandatory. However, in order to use it, a plan administrator must appropriately add relevant information where indicated in the model notice, select among alternative language, and supplement the model notice to reflect applicable plan provisions. Items of information that are not applicable to a particular plan may be deleted. Use of the model election notice appropriately modified and supplemented, will be considered by the Department to satisfy the election notice content requirements of COBRA for single-employer group health plans.”
Employee – An individual representing a company or organization by providing support, services, talent or other skills based on their job duties or descriptions in exchange for wages or salary payments. Also known as worker, staffer, team member, or personnel.
Employee Organization – An employee-based organization or group, such as a labor union, which advocates employee concerns such as wages, scheduling, and employee benefit plans or other matters involving the employment relationship. The organization may represent employees in reaching barganing or other workplace agreements.
Employment Practices Liability (EPL) – An area of United States law that deals with wrongful termination, sexual harassment, discrimination, invasion of privacy, false imprisonment, breach of contract, emotional distress, and wage and hour law violations. Employment Practices Liability is part of professional liability.
Enrollment Date – The first day of coverage or, if there is a waiting period, the first day of the waiting period. If you enroll when first eligible for coverage, your enrollment date is generally the first day of employment. If you enroll as a late enrollee, your enrollment date is the first day of coverage.
EPA – Environmental Protection Agency
EPL – Employment Practices Liability
ERISA (Employee Retirement Income Security Act of 1974) – ERISA is a federal law that regulates employee benefit plans, such as group health plans, that private sector employers, employee organizations (such as unions), or both, offer to employees and their families
ERTA – Economic Recovery Tax Act (1981)
ESOP – Employee Stock Ownership Plans
Excepted Benefits – There are several types of excepted benefits. Certain benefits are always treated as excepted benefits because they are not considered health coverage, such as: Accident Only, Disability Income Insurance, and Workers’ Compensation. Other benefits are treated as excepted benefits if they are offered separately or are not an integral part of the plan, including: Limited-Scope Dental or Vision and Long-Term Care Benefits. Moreover, other benefits are treated as excepted benefits if they are offered separately and not coordinated with benefits under another group health plan, including Coverage for a Specific Disease and Hospital Indemnity or Other Fixed Indemnity. Finally, other benefits are treated as excepted benefits if they are offered as a separate insurance policy and supplemental to Medicare, Armed Forces health care coverage, or (in very limited circumstances) group health plan coverage.
Exhausted COBRA Coverage – Exhausted COBRA coverage refers to the period of time when COBRA continuation coverage has lapsed or expired and the participant is no longer covered by the plan. Other reasons for exhaustion of COBRA may include coverage ending because the employer fails to pay premiums on time or the participant no longer lives or works in a coverage service area and no similar COBRA coverage is available.
FASB – Financial Accounting Standards Board
FCRA – Fair Credit Reporting Act
FICA – Federal Insurance Contributions Act (Social Security and Medicare)
FLSA – The Fair Labor Standards Act
FMLA – The Family and Medical Leave Act
FSA – A Flexible Spending Account (also known as a flexible spending arrangement) is a special account you put money into that you use to pay for certain out-of-pocket health care costs.
FUTA – Federal Unemployment Tax Act (unemployment insurance)
GAAP – Generally accepted accounting principles
GAAS – Generally accepted auditing standards
GAO – General Accounting Office
General Notice – A written notice describing COBRA rights, which must be provided by the plan administrator to each covered employees and covered spouse within 90 days of their beginning coverage under the plan, or within 90 days of the plan becoming subject to COBRA. However, if a qualifying events occurs and you would be required to provide an election notice before the date the general notice is due, the general notice must be provided at the same time as the election notice. Among other things, the general notice must include a description of the COBRA coverage provided under the plan, who may become qualified beneficiaries, and the types of qualifying events that may give rise to the right to COBRA coverage. The Department of Labor has developed a model general notice that is intended to assist plan administrators of single-employer group health plans in satisfying the general notice requirement. Use of this model notice is not mandatory. However, in order to use it, a plan administrator must appropriately add relevant information where indicated in the model notice, select among alternative language, and supplement the model notice to reflect applicable plan provisions. Items of information that are not applicable to a particular plan may be deleted. Use of the model general notice appropriately modified and supplemented, will be considered by the Department to satisfy the general notice content requirements of COBRA for single-employer group health plans.
Genetic Information – A written notice describing COBRA rights, which must be provided by the plan administrator to each covered employees and covered spouse within 90 days of their beginning coverage under the plan, or within 90 days of the plan becoming subject to COBRA. However, if a qualifying events occurs and you would be required to provide an election notice before the date the general notice is due, the general notice must be provided at the same time as the election notice. Among other things, the general notice must include a description of the COBRA coverage provided under the plan, who may become qualified beneficiaries, and the types of qualifying events that may give rise to the right to COBRA coverage. The Department of Labor has developed a model general notice that is intended to assist plan administrators of single-employer group health plans in satisfying the general notice requirement. Use of this model notice is not mandatory. However, in order to use it, a plan administrator must appropriately add relevant information where indicated in the model notice, select among alternative language, and supplement the model notice to reflect applicable plan provisions. Items of information that are not applicable to a particular plan may be deleted. Use of the model general notice appropriately modified and supplemented, will be considered by the Department to satisfy the general notice content requirements of COBRA for single-employer group health plans.
GIC – Guaranteed interest contract
Government compliance – Government issued laws, rules and/or regulations at both the local/state and federal level, which may be applicable to employers and employment services organizations such as the PEO. Some government compliance standards or measures are administered by the U.S. Department of Labor – such as federal minimum wage, child labor laws and workplace safety and health, while others may be enforced by the IRS – such as the filing and remittance of employer and employee taxes, while still others may be managed by state authorities such as State Unemployment benefits.
Governmental Plan – A plan established or maintained for its employees by the Government of the United States, by the government of any state or political subdivision thereof, or by any agency or instrumentality of the foregoing. A governmental plan also includes any plan to which the Railroad Retirement Act of 1935 or 1937 applies, and which is financed by contributions required under that Act and any plan of an international organization which is exempted from taxation under the International Organizations Immunities Act.
Gross Misconduct – The term “gross misconduct” is not specifically defined in COBRA or in regulations under COBRA. Therefore, whether a terminated employee has engaged in “gross misconduct” that will justify a plan in not offering COBRA to that former employee and his or her family members will depend on the specific facts and circumstances. Generally, it can be assumed that being fired for most ordinary reasons, such as excessive absences or generally poor performance, does not amount to “gross misconduct.”
Group Health Plan – An employee benefit plan established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care to employees and their dependents directly or through insurance, reimbursement or otherwise.
HCFA – Health Care Financing Administration
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 coverage includes group health insurance coverage, individual health insurance coverage, and short-term, limited-duration insurance.
Health Insurance Issuer – An insurance company, insurance service, or insurance organization (including an HMO) that is required to be licensed to engage in the business of insurance in a State and that is subject to State law that regulates insurance.
HHS – Department of Health and Human Services
Hidden Preexisting Condition Exclusion – A Hidden Preexisting Condition Exclusion is a plan provision that limits or excludes benefits relating to a condition because the condition was present before an individual’s enrollment date and is then considered “preexisting” and therefore excluded. Examples include: accidental injury coverage only if the injury occured while covered under the plan; the denial of benefits for pregnancy until 12 months after an individual becomes eligible for benefits under a plan; and a provision that counts benefits received under prior health coverage against a lifetime limit. These types of exclusions may not comply with HIPAA laws and therefore should be carefully reviewed.
HIPAA (Health Insurance Portability and Accountability Act) – HIPAA is a federal law that limits pre-existing condition exclusions, permits special enrollment when certain life or work events occur, prohibits discrimination against employees and dependents based on their health status, and guarantees availability and renewability of health coverage to certain employees and individuals.
HMO (Health Maintenance Organization) – Legal entity consisting of participating medical providers that provide or arrange for care to be furnished to a given population group for a fixed fee per person. HMOs are used as alternatives to traditional indemnity plans.
HR – Human Resources
HSA – Health Savings Account
INS – Immigration and Naturalization Service, a unit of the Department of Justice
Insured – Benefits under a plan that are guaranteed under a contract or policy of insurance issued by a health insurance issuer. For information on whether your plan is insured, contact your plan administrator or consult your SPD. Plans that do not meet this definition may be self-insured.
IRA – Individual Retirement Account
IRC – Internal Revenue Code
IRS – Internal Revenue Service
ISO – Incentive stock option
LAN – Local Area Network
Late Enrollee – An individual who enrolls in a group health plan on a date other than either the earliest date on which coverage can begin under the plan terms or on a special enrollment date. Under HIPAA, a late enrollee may be subject to a maximum pre-existing condition exclusion of up to 18 months.
Lifetime Dollar Limit – With respect to benefits under a group health plan or health insurance coverage, a dollar limitation on the total amount that may be paid with respect to such benefits under the plan or health insurance coverage with respect to an individual or other coverage unit.
LTC – Long-Term Care
LTD – Long-Term Disability
Medical/Surgical Benefits – Benefits to cover medical or surgical services which are defined under the plan’s coverage terms. These do not include Mental Health benefits.
Mental Health Benefits – Benefits to cover mental health services which are defined under the plan’s coverage terms. These do not include treatment of substance abuse or chemical dependency.
Mental Health Parity Act (MHPA) – MHPA is a federal law that requires annual or lifetime dollar limits on mental health benefits provided by a group health plan to be no lower than the annual or lifetime dollar limits for medical and surgical benefits offered by that plan. MHPA applies to employers with more than 50 employees.
MEPPAA – Multiemployer Pension Plan Amendments Act (1980)
MHPA – The Mental Health Parity Act
MSA – Medical Savings Account
Multiemployer Plan – A retirement or pension plan established through collective barganing agreements where more than one employer maintain the plan and are required to contribute.
Multiple Employer Welfare Arrangement (MEWA) – MEWAs provide health and welfare benefits to employees of two or more unrelated employers and who are not involved in collective bargaining agreements. MEWAs are designed to provide small employers access to low cost health insurance similar to that available to larger employers.
NASDAQ – National Association of Securities Dealers Automated Quotation
Newborns’ and Mothers’ Health Protection Act (Newborns’ Act) – A federal law that prohibits group health plans and insurance companies (including HMOs) that cover hospitalization in connection with childbirth from restricting a mother’s or newborn’s benefits for such hospital stays to less than 48 hours following a vaginal delivery or 96 hours following delivery by cesarean section, unless the attending doctor, nurse midwife or other licensed health care provider, in consultation with the mother, discharges earlier.
NLRB – National Labor Relations Board
NMHPA – The Newborns’ and Mothers’ Health Protection Act of 1996
NOL – Net operating loss
OASDI – Old-age, survivors and disability income
Onboarding – Onboarding or New Hire Process is a mechanism (or process) used to assist in the adjustment period of a newly hired employee of an organization. The steps may vary from organization to organization but the main elements include the socialization and adaptation of an individual to a new organization as well as the transfer of important knowledge, skills and behaviors deemed essential to the success of the new hire as well as the organization. The process typically includes offer lettter/job acceptance, new hire forms/documentation, company benefit overview and enrollment, company or department orientation, training and ongoing development and introductory period as well as fixed period evaluations, coaching and mentoring.
OOP – Out of Pocket costs: Your expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copayments for covered services plus all costs for services that aren’t covered.
OSHA – Occupational Safety and Health Administration
P/E – Price/earnings
Paperless – A paperless office is a work environment in which the use of paper is eliminated or greatly reduced. This is done by converting documents and other papers into digital form. Proponents claim that “going paperless” can save money, boost productivity, save space, make documentation and information sharing easier, keep personal information more secure, and help the environment.
Participant – A participant is a member of an employer-sponsored benefit plan. The participant could be an active employee, former employee and/or dependents or beneficiaries of such employees, based on the eligibility circumstances of the participant.
PBGC – Pension Benefit Guaranty Corporation
PBM – Pharmacy Benefit Manager
PIN – Personal identification number
Plan Administrator – A Plan Administrator is responsible for the structuring, management and compliance of certain company group benefits such as Health and/or Retirement plans. The Plan Sponsor typically refers to the employer or employment services organization offering the plan or benefit and the Plan Administrator is usually determined by the terms of the plan.
Plan Sponsor – Generally, the employer, the employee organization (such as a union), or both, that establishes or maintains an employee benefit plan, including a group health plan.
POS – Point of Service health plan
PPACA – Patient Protection and Affordable Care Act (2010)
PPO – Preferred Provider Organization
PPS – Professional practices section
Pre-existing Condition – An illness or condition that was present before an individual’s first day of coverage under a group health plan.
Pre-existing Condition Exclusion – A limitation or exclusion of benefits for a condition based on the fact that you had the condition before your enrollment date in the group health plan. A pre-existing condition exclusion may be applied to your condition only if the condition is one for which medical advice, diagnosis, care or treatment was recommended or received within the 6 months before your enrollment date in the plan. A pre-existing condition exclusion cannot be applied to pregnancy (regardless of whether the woman had previous coverage), or to genetic information in the absence of a diagnosis. A pre-existing condition exclusion also cannot be applied to a newborn or a child who is adopted or placed for adoption if the child has health coverage within 30 days of birth, adoption or placement for adoption and does not later have a significant break in coverage. If a plan provides coverage to you through an HMO that has an affiliation period, the plan cannot apply a pre-existing condition exclusion. A pre-existing condition exclusion can not be longer than 12 months from your enrollment date (18 months for a late enrollee). A pre-existing condition exclusion that is applied to you must be reduced by the prior creditable coverage you have that was not interrupted by a significant break in coverage. You may show creditable coverage through a certificate of creditable coverage given to you by your prior plan or insurer (including an HMO) or by other proof. The plan can apply a pre-existing condition exclusion to you only if it has first given you written notice. If your plan has both a waiting period and a pre-existing condition exclusion, the exclusion begins when the waiting period begins. In some states, if plan coverage is provided through an insurance policy or HMO, you may have more protections with respect to pre-existing condition exclusions. The Department has developed a model general notice of pre-existing condition exclusion and a model individual notice of pre-existing condition exclusion that can be used by a group health plan or a health insurance issuer. Correct use of the model notices will general assure compliance with regulatory requirements.
Pre-existing Condition Exclusion Period – The period of time that a group health plan can legally limit your access to the health benefits offered by that plan because of a pre-existing condition. Under HIPAA, the maximum pre-existing condition exclusion period that can be applied to an individual is 12 months (18 months for late enrollees).
Premium – The amount paid or to be paid by the policyholder for coverage under the contract, usually in periodic installments.
PWBA – Pension and Welfare Benefits Administration
QTIP – Qualified terminable interest property
Qualified Beneficiary – Generally, qualified beneficiaries include covered employees, their spouses (or former spouses) and their dependent children who are covered under the group health plan on the day before the qualifying event. In certain cases, retired employees, their spouses and dependent children may be qualified beneficiaries. In addition, any child born to, or placed for adoption with, a covered employee during a period of COBRA continuation coverage is a qualified beneficiary. A qualified beneficiary who has elected COBRA coverage should be considered a participant under the plan for purpose of the disclosure requirements under Part I of ERISA (such as, provision of a summary plan description (SPD).
Qualifying Event – Certain events that would ordinarily cause an individual to lose health coverage. The type of qualifying event will determine who the qualified beneficiaries for the qualifying event are and the length of time COBRA continuation coverage is available.
RBRVS – Resource-based relative values scale
RFP – Request for proposal
RICO – Racketeer Influenced and Corrupt Organization Act (1970)
ROA – Return on assets
ROE – Return on equity
ROI – Return on investment
SBA – Small Business Administration (http://www.sba.gov/)
SBIC – Small business investment corporation
SBU – Strategic business unit
Second Qualifying Event – Certain events may entitle a qualified beneficiary who is receiving an 18-month maximum period of COBRA coverage to an 18-month extension of COBRA coverage (for a total maximum period of 36 months of COBRA coverage). These events are: the death of the covered employee; the divorce or legal separation of the covered employee and spouse; the covered employee’s becoming entitled to Medicare (Medicare entitlement of a covered employee is not a second qualifying event for a qualified beneficiary unless the Medicare entitlement would have resulted in a loss of coverage under the plan for the qualified beneficiary.); or a loss of dependent child status under the plan. The second event can be a second qualifying event only if it would have caused the qualified beneficiary to lose coverage under the plan in the absence of the first qualifying event.
SEP – Simplified Employee Pension plan
SEPPAA – Single-Employer Pension Plan Amendments Act (1986)
SIC – Standard Industrial Classification
Significant Break in Coverage – Generally, a significant break in coverage is a period of 63 consecutive days during which you have no creditable coverage. In some states, the period is longer if your plan coverage is provided through an insurance policy or HMO. Days in a waiting period during which you had no other health coverage cannot be counted toward determining a significant break in coverage.
Similarly Situated Non-COBRA Beneficiaries – The group of covered employees, their spouses or dependent children who are covered under a group health plan maintained by the employer or employee organization. This group is receiving their benefits under the group plan and not through COBRA continuation coverage. They are most similarly situated to the circumstances of thequalified beneficiary immediately before the qualifying event.
SIMPLE – Simplified Employee Pension Plan
SIP – Supplemental income plan
SMSA – Standard metropolitan statistical area
SPD (Summary Plan Description) – An important document that the plan administrator must automatically provide to participants which explains what coverage the plan offers, how the plan operates and the rights and responsibilities of participants and beneficiaries. A SPD also must be given to participants and beneficiaries upon request. Each plan’s SPD is different. If you need a copy of the SPD, contact your plan administrator.
Special Enrollment – The opportunity to enroll in a group health plan when certain work or life events occur, regardless of the plan’s regular enrollment dates. Generally, if certain conditions are met, special enrollment is available when you, your spouse or your dependents lose other coverage (including exhaustion of COBRA continuation coverage), when you marry or when you have a new child by birth, adoption or placement for adoption. The plan must give you at least 30 days–from the loss of coverage or from the date of the marriage, birth, adoption or placement for adoption–to request special enrollment. The maximum pre-existing condition exclusion that may be applied to a person upon special enrollment is 12 months (reduced by the person’s prior creditable coverage). However, if enrolled within 30 days of birth, adoption or placement for adoption, children may be exempt from any pre-existing condition exclusion. A description of a plan’s special enrollment rules must be given to the employee on or before the time the employee is offered the opportunity to enroll in the plan. The Department has developed a model special enrollment notice that may be used by a group health plan or health insurance issuer. Correct use of the model will generally assure compliance with the regulatory requirements.
SSA – Social Security Administration (http://www.ssa.gov/)
SSI – Supplemental Security Income
STD – Short-Term Disability
SUTA – State Unemployment Tax Act
TAMRA – Technical and Miscellaneous Revenue Act
TEFRA – Tax Equity and Fiscal Responsibility Act (1982)
TIN – taxpayer identification number
TitleVII – Civil Rights Act of 1964
TNC – Transnational corporation
TPA – Third Party Administrator
TRA ’86 – Tax Reform Act of 1986
USC – United States Code
VA – Veterans Administration
VAT – Value-added tax
VEBA – Voluntary Employee’s Beneficiary Association
VRM – Variable rate mortgage
W2 – United States federal tax form issued by employers and stating how much an employee was paid in a year.
Waiting Period – The period that must pass before an employee or dependent is eligible to enroll (becomes covered) under the terms of the group health plan. If the employee or dependent enrolls as a late enrollee or on a special enrollment date, any period before the late or special enrollment is not a waiting period. If a plan has a waiting period and a pre-existing condition exclusion, the pre-existing condition exclusion period begins when the waiting period begins. Days in a waiting period are not counted toward creditable coverage unless there is other creditable coverage during that time. You should try to maintain creditable coverage during a waiting period to reduce any pre-existing condition exclusion that may apply. Days in a waiting period are also not counted when determining a significant break in coverage.
Welfare Benefit Plan – Any plan, fund, or program established or maintained by an employer or employee organization, or by both, to provide participants and their beneficiaries, through the purchase of insurance or otherwise, with certain benefits, including medical, surgical, or hospital care or benefits.
WHCRA – The Women’s Health and Cancer Rights Act of 1998
Women’s Health and Cancer Rights Act – The Women’s Health and Cancer Rights Act is a federal law that provides important protections for individuals who have undergone a mastectomy.