August
Benefits 101: Class is Almost in Session!
Gearing up for back-to-school? Let's come to terms with it.
The back-to-school buzz isn’t just for kids — this is the perfect time to sharpen your benefits know-how and make the most of the benefits available to you. Whether you're new to our team or need a refresher, we’ve got you covered with simple, helpful, and common benefit terms. No pop quiz required!
Your homework assignment
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Log in to your benefits portal and do a quick review of what you chose last year.
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Be on the lookout for benefit information from your HR team. Don’t hit snooze!
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Explore what’s new for this year.
- Task yourself to learn more about a benefit that you haven’t utilized yet.
A great benefit you may be missing:
An employee assistance program helps you navigate stress, family dynamics, finances, or legal questions — confidentially and at no cost. Don’t wait for a crisis to explore what’s available.
- Benefit: Coverage for services available in accordance with the terms of your healthcare coverage.
- Coinsurance: Coinsurance is your share of the costs of a covered healthcare service, calculated as a percentage (for example, 20%) of the allowed amount for the service. Your coinsurance will begin after you have met your deductible. For example, if the health plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health plan pays the rest of the allowed amount.
- Copay/Copayment: A copay is a fixed dollar amount you pay for a healthcare service. The amount can vary by the type of service. Your copays will not count toward your deductible but will count toward your out-of-pocket maximum.
- Deductible: The deductible is the amount you owe for covered healthcare services before your plan begins to pay benefits. For example, if your deductible is $2,800, your insurance won’t start paying for certain services until you’ve spent $2,800 out of your own pocket. After your deductible has been met, your plan will start to pay for covered services based on your coinsurance. Preventive care is not subject to the deductible, as it is covered 100% by any medical plan option.
- Explanation of Benefits (EOB): An EOB is a statement from the insurance company showing how claims were processed. The EOB tells you what portion of the claim was paid to the healthcare provider and what portion of the payment, if any, you are responsible for paying.
- In-Network Versus Out-of-Network: A network is composed of all contracted providers. Networks request providers to participate in their network, and in return, providers agree to offer discounted services to their patients. If you pick an out-of-network provider, your claims will be higher because you will not receive the discounts the in-network providers offer.
- Out-of-Pocket Maximum: The most you pay each year for covered expenses. Once you’ve reached the out-of-pocket maximum, the health plan pays 100% for covered expenses.
- Premium/Contribution: The amount a member or group pays on a periodic basis for coverage as defined in the member’s health insurance certificate or contract.
- Qualifying Life Event (QLE): A QLE allows you to make changes to your benefits during the year ONLY if you have a qualifying event resulting in a “change in family status.” What is considered a qualifying event? Your marriage, legal separation, or divorce; the birth or adoption of a child; the loss of coverage eligibility for a dependent child; the loss of coverage under your spouse’s or other employer’s plan; and the death of a spouse or dependent child.
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Vesting: A participant’s right of ownership to the money in their plan account. A participant’s contributions and their earnings are always 100% vested; however, company contributions and employer matching contributions may become vested over a period of time.
