The most a plan member will pay per year for covered health expenses before the plan pays 100% of covered health expenses for the rest of that year.

The portion of eligible expenses that plan members are responsible paying, most often after the deductible is met. It's usually determined as a percentage of the total cost.

A federal statute that requires most employers to offer to covered employees and covered dependents who would otherwise lose health coverage for reasons specified in the statute, the opportunity to purchase the same health benefits coverage that the employer provides to its remaining employees. This continuation of coverage can only last for a maximum specified period of time (usually 18 months for employees and dependents who would otherwise lose coverage due to loss of employment or work hour reduction, or 36 months for dependents who would lose coverage for certain reasons other than employment loss by the employee).

The benefits that are provided according to the terms of a participant's specific health benefits plan.

The dollar amount that a plan member must pay for eligible health expenses before a traditional health plan kicks in with benefits.

A person eligible for coverage under an employee benefits plan because of that person's relationship to an employee. Spouses, children and adopted children are often eligible for dependent coverage.

The date on which coverage under a health benefits plan begins.

A statement provided by the health benefits administrator that explains the benefits provided, the allowable reimbursement amounts, any deductibles, coinsurance or other adjustments taken and the net amount paid. A participant typically receives an explanation of benefits with a claim reimbursement check or as confirmation that a claim has been paid directly to the provider.

A list of preferred, commonly prescribed prescription drugs. These drugs are chosen by a team of doctors and pharmacists because of their clinical superiority, safety, ease of use and cost.

A prescription drug that has the same active-ingredient formula as a brand-name drug. A generic drug is known only by its formula name and its formula is available to any pharmaceutical company. Generic drugs are rated by the Food and Drug Administration (FDA) to be as safe and as effective as brand-name drugs and are typically less costly.

Health Insurance Portability and Accountability Act of 1996. The law has several parts: The first part addresses health insurance portability and is designed to protect health insurance coverage for workers and their families when they change or lose their jobs. Another part of the law is designed to reduce the administrative costs of providing and paying for healthcare through standardization. The law also includes requirements to protect the privacy of individuals' protected health information. Health plans, providers and other organizations with access to protected health information are covered by the requirements of HIPAA.

Any health care provider (physician, hospital, etc.) that belongs to a network. Staying in-network gives members the advantage of significant discounts, helping to stretch their account dollars further.

The process by which the carrier determines whether it will allow coverage that was not selected during the normal eligibility period.

Medications that are prescribed for long-term treatment of chronic conditions, such as diabetes, high blood pressure or asthma.

Type of coverage that usually pays only a portion of the expense for all covered services (generally involving major illness and injuries) and specifies a deductible that the insured must first pay.

A period when eligible persons can enroll in a health benefits plan.

Any health care provider that does not belong to a network. Members can use their benefits for out-of-network expenses, but miss out on in-network discounts.

Copayments, deductibles or fees paid by participants for health services or prescriptions.

The most a plan member will pay per year for covered health expenses before the plan pays 100% of covered health expenses for the rest of that year.

A health condition (other than a pregnancy) or medical problem that was diagnosed or treated before enrollment in a new health plan or insurance policy.

The fee for providing a health care service which is consistent with the charge in a certain geographical area for identical or similar services.

In order to become eligible for coverage under the policy, an employee must satisfy a certain number of continuous days of service as an active, full-time employee. This is known as the waiting period. In addition, a waiting period can also be the time period between when a disability occurs and when payments from the disability insurance policy begin.