Open Enrollment Center

Employee Benefits

Terms to Know

Open Enrollment 2017

Understanding your benefits is key to saving money and making the most of what’s available to you. Here are frequently used terms that you may come across in your benefits materials during Open Enrollment. Please note that definitions may vary based on your specific policy or plan.

Claim

A request for payment that you or your healthcare provider submits to your health insurer when you receive covered services or products.

Co-insurance

The amount or percentage that you pay for certain covered healthcare services under your health plan. This is typically the amount paid after the deductible is met and can vary based on plan design.

Commuter Benefits

Offered through your employer, commuter benefits allow you to use pre-tax dollars to pay for public transit—including train, subway, bus, ferry, and eligible vanpool—and/or qualified parking as part of your daily commute to work. Learn more about WageWorks Commuter Benefits.

Consumer-Directed Benefits (CDBs)

Tax-advantaged accounts that allow participants to use tax-free money to pay for eligible, out-of-pocket expenses. For example, a Health Savings Account (HSA) can be used to pay for eligible healthcare expenses not covered by insurance, such as copays and prescriptions.

Copayment (or Copay)

A fixed amount (for example, $20) you pay for a covered healthcare service. The copay amount can vary based on your type of healthcare coverage and the type of service. In general, plans with lower monthly premiums have higher copays and plans with higher monthly premiums typically have lower copays.

Deductible

The amount you pay out-of-pocket for covered healthcare services before your insurance plan begins to pay any expenses. For example, if your health plan has a $1,500 deductible, you are required to pay the first $1,500 of covered services. The deductible may not apply to all services, so it’s important to review plan details for specific requirements.

Dependent Care Flexible Spending Account (FSA)

A pre-tax benefit account offered by your employer that you can use to pay for eligible dependent care expenses, such as child daycare, preschool, summer day camp, or elder daycare. Find out how a WageWorks Dependent Care FSA can help you save while taking care of your loved ones.

Dependents

Generally, the spouse, qualifying children or family members of a covered employee.

Effective Date

The date that coverage becomes active. For CDBs, this is the date when you begin contributing to your account and can access available funds.

Healthcare Flexible Spending Account (FSA)

A pre-tax benefit account offered by your employer that you can use to pay for eligible out-of-pocket medical expenses that aren’t covered by your insurance plan. You decide how much to contribute to your FSA each year and funds are withdrawn automatically from each paycheck for deposit into your account before taxes are deducted. The total amount you elect to contribute to your Healthcare FSA each year is available on the first day of your plan year. Learn how a WageWorks Healthcare FSA is a smart, simple way to save money while keeping you and your family healthy and protected.

Healthcare Flexible Spending Account (FSA) with Carryover

A pre-tax benefit account offered by your employer that you can use to pay for eligible, out-of-pocket healthcare expenses. This type of Healthcare FSA allows you to carry over up to $500 of unused FSA funds from one plan year to the next. Get more information on how a WageWorks Healthcare FSA with Carryover brings the benefits of an FSA without the need to “use it or lose it” at the end of each year.

Health Reimbursement Arrangement (HRA)

An employer-sponsored account to reimburse a portion of your eligible, out-of-pocket medical expenses, such as deductibles, co-insurance, and pharmacy expenses. While not an insurance plan, this reimbursement account is funded entirely by your employer to help make your healthcare more affordable – you cannot contribute to an HRA. Your employer determines which expenses are covered by an HRA, so it’s important to review your plan details carefully. If this option is available to you, check out more details about WageWorks HRAs.

Health Savings Account (HSA)

A pre-tax benefit account that works in conjunction with an HSA-qualifying high-deductible health plan. HSA funds can cover eligible, out-of-pocket medical, vision, and dental expenses. Similar to a 401(k), HSA participants own their accounts and have complete control over how the money is used to pay for eligible expenses—regardless of whether they change plans, retire, or change jobs. Unlike a 401(k), participants can use HSA funds to pay for eligible expenses at any time without paying taxes or penalties on the amount. Find out how a WageWorks HSA can help you lower your healthcare costs today while saving money for future healthcare expenses. And check out how you can preserve your HSA dollars by having an HSA-Compatible FSA.

HSA-qualified High-deductible Health Plan (HDHP)

A healthcare plan in which subscribers pay significantly lower premiums in exchange for being responsible for higher initial medical costs (deductibles) and higher out-of-pocket maximum expenses. For 2017, the IRS defines an HSA-qualified high-deductible health plan as a plan with a deductible of at least $1,300 for an individual or $2,600 for a family.

HSA-Compatible Flexible Spending Account (FSA)

A pre-tax benefit account offered by your employer that helps you maximize HSA dollars. The HSA-Compatible FSA is much like a Healthcare FSA, but eligible expenses are limited to qualifying dental and vision expenses. Learn how a WageWorks HSA-Compatible FSA can help you save on out-of-pocket expenses while taking advantage of the long-term savings power of an HSA.

Out-of-pocket Expenses

Amount that you must pay toward the cost of services or products that are not covered by insurance. For healthcare-related expenses, this can include deductibles, copays, co-insurance, prescription drugs and hundreds of eligible over-the-counter supplies.

Premium

Amount you pay for your healthcare, dental or vision insurance every month. In addition to the premium, you typically have other healthcare-related costs, such as a deductible, copays or co-insurance.

Pre-tax Deduction

Money deducted from your paycheck before Medicare, federal and state taxes are taken out, reducing your tax liability.

Subscriber

The person who signs up for the insurance plan and pays for the policy.

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