Benefits Glossary

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Benefits Glossary

Expand your benefits vocabulary and understand your plan.

All-Source Maximum (applicable to LTD and STD claims only) The maximum percentage of your regular earnings you can claim from all benefit sources combined - Employment Insurance, Group Benefits Plan, Workers' Compensation, etc.
Accidental Death and Dismemberment (AD&D) If you pass away or are dismembered by unnatural or accidental causes.
Beneficiary The individual or entity who will receive the benefits upon your death.
Benefits The amounts paid to you or your beneficiary as a result of a claim. Also used to identify categories of insurance.
Broker aka advisor, consultant, agent. The entity that acts as an intermediary between the insurer and the client (you).
Claim A request to your insurance company asking for payment for a covered service or benefit.
Claimant The individual who makes a claim (you!).
Co-insurance A type of insurance where the cost of a covered service is shared between you and your plan by percentage.
Co-payment A fixed amount you must pay towards the cost of a covered service.
Critical Illness Insurance (CI) Provides a benefit to be paid in the event you are diagnosed with a serious illness. (See your booklet for a list of Covered Conditions).
Deductible A specified amount that you must pay for a covered service before the insurance company will pay a claim.
Dependent Your legal spouse or child.
Dependent Life A fixed amount of insurance paid to you if your legal spouse or child passes away from natural causes.
Dispensing Fee A professional fee charged by a pharmacist when dispensing a prescription.
Earnings Your regular rate of pay from your employer. It may include regular bonuses and overtime pay.
Employer aka plan sponsor, contract holder.
Experience-rated Benefits Benefits that are rated based on your group's past claims experience. Typically: health and dental benefits.
Group Benefits (or Group Insurance) A benefit plan that provides insurance coverage to a group of people.
Health (Care) Spending Account (HSA or HCSA) An allotted dollar amount that can provide reimbursement for a wide range of health-related expenses, either instead of or alongside regular benefit plans.
Insured aka plan member, employee, participant (you!).
Insurer aka carrier, insurance company. This is the risk holder and the claims payer.
Irrevocable Beneficiary A beneficiary that cannot be changed by you without their consent.
Long-term Disability (LTD) If you become 'Totally Disabled' (per the definition and period outlined in the contract), you will be eligible to receive a monthly benefit paid by the insurer.
Medical underwriting the use of medical or health information in the evaluation of an applicant for coverage, typically for life or health insurance.
Non-Evidence Maximum/Limit The amount of insurance available without providing medical evidence to the insurance company.
Optional Life Insurance Additional life insurance available to purchase on an optional basis.
Paramedical Non-traditional healthcare solutions, such as massage therapy, acupuncture, chiropractic and nutritionists.
Pooled Benefits Benefits that are rated based on group demographics. Typically: Life, AD&D, Dependent Life, LTD, and CI benefits.
Premium An amount payable by an individual or business for insurance coverage. Typically paid monthly, quarterly, or annually.
Reasonable and Customary Charges The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar service. Determined by the insurance company, applicable professional association fee guide, or established by law.
Revocable Beneficiary A beneficiary that can be changed by you without their consent.
Short-term Disability (STD) If you become ill or injured and cannot perform duties your job duties, you will be eligible to receive a weekly benefit paid by the insurer.
Target Loss Ratio (TLR) The difference between premiums received by an insurance carrier and the claims they have paid. This is expressed as a percentage and typically runs between 60-80%; the remaining percentage is used to cover administrative costs.
Third-Party Administrator (TPA) a company that administers all or part of a group benefits plan (enrolling, billing, premium collection) but is not the insurer of the plan.
Weekly Indemnity (WI) see Short-term Disability.
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