Skip to main content
Employee Benefits

Your Open Enrollment Dictionary

We’ve all been there. You’re sitting through an open enrollment meeting at work or skimming through your benefits packet. You’re expected to make major decisions, but you’re left with more questions than answers. What do all these terms mean? How do they impact me? How do they impact my family?

Let us help you better understand all the terms you’re seeing during open enrollment so you can make the best choices for you and your family.

Open Enrollment
Open enrollment is the period of time when you may enroll yourself and/or dependents, disenroll yourself and/or dependents, or change your benefit elections.  After the enrollment deadline, you may not change your benefit elections until the next open enrollment period unless you have a qualifying event.

Qualifying Event
Qualifying events include:

  • Marriage, divorce or legal separation (state specific)
  • You add a dependent child through birth, adoption or court-ordered custody
  • Death of a spouse or child
  • Your work schedule changes, affecting benefits, i.e. reduction or increase in hours, affecting eligibility
  • Your dependent loses eligibility for coverage
  • Your spouse involuntarily loses health coverage through his/ her employer
  • You take an FMLA leave of absence
  • You and/or your spouse and dependents become eligible for COBRA
  • You and/or your spouse or dependents gain or lose Medicaid coverage
  • You receive a Qualified Medical Child Support Order (QMCSO)
  • You and/or your spouse or dependent loses coverage under State Children’s Health Insurance Program (SCHIP) under Title XXI of the Social Security Act
  • You and/or your spouse or dependent becomes eligible for group health plan premium assistance under Medicaid or SCHIP plan

You may make a new election within 30 or 60 days of the occurrence of an event described in this section, as applicable.

Deductible
A specific dollar amount you must pay out of pocket before your insurance starts to pay.  Under some plans, the deductible is waived for certain services and is always waived for preventive care.

Coinsurance
The percentage you pay for certain covered health care services.  This is typically paid after the deductible is met and can vary based on plan design.  For example, once you meet your deductible, you may be required to pay 20% of certain covered health care services, and your health insurer will pay 80%.

Copay
A flat fee you pay toward the cost of covered medical services (i.e., a doctor’s office visit).  Copays are often also charged for prescription drugs.

In-Network
Health care received from physicians and health care facilities participating with your health insurance carrier’s plan which will provide you with the highest level of benefits.

Flexible Savings Accounts (FSA)
A flexible spending account (FSA) is an account that reimburses you for qualified health care or dependent care expenses. An FSA can be funded with pre-tax dollars deducted from your paycheck.  You can receive cash reimbursement up to the total value of your account for covered expenses incurred during the benefit plan year and any applicable grace period.

Health Savings Account (HSA)
A health savings account (HSA) is an account funded to help you save for future medical expenses. There are certain advantages to putting money into these accounts, including favorable tax treatment.  In order to open an HSA, you must be enrolled in a Qualified High Deductible Health Plan as defined by the IRS, and you must be eligible.

Contributions to your HSA can be made by you, your employer or both, but the total contributions are limited annually.  Your contributions can be deducted from your federal income tax return.  Some employers will allow you to make HSA contributions through pre-tax payroll deductions.

You can use your HSA funds to pay for any qualified medical expenses permitted under federal tax law which includes most medical, dental and vision care.

Are there other terms you’d like us to help you understand? Submit them here: info@ekmcconkey.com

Brenda Snyder, GBA, HIA, PHIAS


Author Brenda Snyder, GBA, HIA, PHIAS


Senior Consultant - Benefits
bsnyder@ekmcconkey.com
717-505-3166

More posts by Brenda Snyder, GBA, HIA, PHIAS

Skip to content