Benefits Glossary

Defined below are some of the terms that you may encounter while enrolling in benefits at UNC-Chapel Hill. If you have questions about benefits or benefits enrollment, please contact your Benefits Consultant.

Coinsurance

The percentage of costs of a covered health care service you pay (20%, for example) after you’ve paid your deductible.

Let’s say your health insurance plan’s allowed amount for an office visit is $100 and your coinsurance is 20%.

·     If you’ve paid your deductible: You pay 20% of $100, or $20. The insurance company pays the rest.

·     If you haven’t met your deductible: You pay the full allowed amount, $100.

Copayment

A fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible.

Deductible

The amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself.

Formulary

A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Health Reimbursement Account (HRA)

Health Reimbursement Accounts (HRAs) are employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year.

Unused amounts may be rolled over to be used in subsequent years. The employer funds and owns the account. Health Reimbursement Accounts are sometimes called Health Reimbursement Arrangements.

Plan Year

A 12-month period of benefits coverage under a group health plan. Our plan year runs January 1 through December 31.

Preferred Provider Organization (PPO)

A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.

Premium

The amount you pay for your health insurance every month. In addition to your premium, you usually have to pay other costs for your health care, including a deductible, copayments, and coinsurance. If you have a Marketplace health plan, you may be able to lower your costs with a premium tax credit.

Preventive Services

Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.

Qualifying Life Event (QLE)

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

Vesting

“Vesting” in a retirement plan means ownership. An employee who is 100% vested in his or her account balance owns 100% of it and the employer cannot forfeit, or take it back, for any reason.