accidental death and dismemberment (AD&D) insurance that pays a benefit when there is a loss of life, limb or eyesight as the result of an accident.

 accrual
 
 

• retirement plans earning or accumulating credits (in a defined-benefit plan) or funds (in a defined-contribution plan).

 
• other benefits earning or accumulating hours, days or weeks, e.g. earning hours to be taken later as paid vacation.

 ADA Americans with Disabilities Act of 1990; prohibits discrimination in employment based on disability.

 AD&D see "accidental death & dismemberment"

 age-related premium an insurance premium rate that is based upon the age of the insured.

 annuity periodic payments made to a benefit recipient, e.g. a monthly retirement benefit. (Contrasted to a lump sum)

 application the act of requesting (applying for) a benefit.

assignment (in health care) the authorization by a participant that a benefit/payment be made directly to the provider of services.

balance billing the act by a provider of service, e.g. dentist, of requesting payment from one party for the difference between what has been received (from a second party) and the total expense for the service.

beneficiary a person or entity designated to receive a benefit as a result of the death of the participant.

bill request for payment for services rendered.

 cap the maximum limit, e.g. the maximum amount of years of service that will be recognized, or the maximum amount of expenses for which one will be responsible.

carrier an insurance company or other agency that administers a program such as life insurance or medical coverage.

 claim a demand for payment, either by a participant in a plan or by a provider of services.

claimant participant in a plan (e.g. an employee) or beneficiary who files for a benefit.

COBRA Consolidated Omnibus Budget Reconciliation Act of 1985; a federal law that significantly affects health plans by mandating the offer of the continuation of coverage for an employee or dependents subject to certain requirements.

 COLA Cost of Living Adjustment; across-the-board increase (or decrease) in compensation, including retirement income, based upon the change in a prescribed index, e.g. CPI.

 contingent beneficiary [annuitant] beneficiary [of an annuity payment] in the event of the death of the primary beneficiary [annuitant].

 contributory requires contributions (either in whole or part) by an employee/participant.

conversion of coverage when coverage under a group insurance contract ends, the act of obtaining individual insurance (typically at greater premium rates).

 coordinate the addition of two or more benefits, such that the sum does not exceed 100% (or other rate), used to eliminate duplication of benefits (or income)

 copayment a stated amount of payment required by the recipient of a service; can be stated either as a dollar amount or as a percentage of the eligible expense.

 covered when a person has satisfied the requirements to be entitled to a benefit; when an expense will be recognized for determining a benefit. (See also "eligible." An individual may be eligible for, but not covered by, a benefit plan.)

credited service the period of employment that is recognized as service for one or more benefit plans. (For the WHOI Retirement Plan, it is the service in a "Plan Year," i.e. a calendar year, that is recognized for either determining vesting or computing the amount of the benefit.)

DB plan see "defined benefit plan"

DC plan see "defined contribution plan"

 deductible the amount of out-of-pocket expense that is first borne by the insured/covered individual before a plan pays a benefit.

deduction [from salary] the employee's share of (premium) expense that is contributed via payroll, subject to current income tax. (See reduction [of salary].)

defined benefit (DB) plan a retirement plan that specifies the benefit, or the method(s) for calculating the benefit.

defined contribution (DC) plan a retirement plan that specifies how much is contributed on behalf of a participant. The benefit is whatever the accumulated contributions can purchase.

 dependent generally, a spouse or child(ren) of a participant; for some benefits, it may include a parent or other family member. Dependent is defined by each respective benefit plan or contract.

EAP see "Employee Assistance Plan"

eligible recognized or covered for purposes of determining a benefit. (See "covered." An individual may be eligible for, but not covered by, a benefit plan.)

 emergency leave (for the Institution specifically) paid time-off granted for either a death in the immediate family, or for when the Institution closes due to inclement weather.

 employee assistance plan (EAP) a program that is available for covered individuals, either an employee or family members, that provides counseling or other service for personal problems, e.g. alcoholism, substance abuse, physical abuse, mental illness, etc. Generally, the service is provided by an outside service, typically for a short-term, and always confidential.

 employer match a contribution (typically to a retirement or savings plan) by the employer that is directly related to what a participant contributes, e.g. 1:1 or 0.5:1.

 ESAP the Institution's EAP. See "Employee Assistance Plan."

 flexible benefits the choice of nontaxable plans and permissible taxable benefits, including cash, governed by Section 125 of the Internal Revenue Code. May be limited to a health and welfare plan that offers the choice of pre-tax premium deductions, or as grand as selection among various benefits, with pre- or post-tax deductions, various levels of benefits, spending accounts, or cash. (Also referred to as cafeteria plan or Section 125 plan.)

 flexible spending account (FSA) an account by which an employee uses pre-tax deductions to accumulate funds for reimbursement of eligible expenses, governed by Section 125 of the Internal Revenue Code. Such accounts reduce taxable wages, and the funds are designated for use to reimburse either health care expenses or dependent care expenses. The funds must be used in the same plan year or forfeited by the employee/participant. (Also referred to as reimbursement account.)

 FSA see "flexible spending account"

 health maintenance organization (HMO) prepaid medical service group that emphasizes preventive health care. It is often characterized by predetermined health benefits in a specific "service area," with no claim forms required of the participant.

 health plan refers to either medical, dental or vision coverage.

 HMO see "health maintenance organization"

 imputed [income] defined by an authority; assumed [cost associated with group term life insurance in ecess of $50,000]. (For example, the Internal Revenue Code specifies that the cost of group life insurance in excess of $50,000 must be included in the income of the insured employee.)

 indemnity plan a "traditional" group health plan that provides for cash payments for specific covered services. Payment may be to the participant or assigned to the provider of the service.

 individual practice association (IPA) a type of HMO that uses a panel of health care providers that are in individual or small group practice.

 individual retirement account (IRA) a savings account that allows an participant to set aside up to $2,000 per year. Contributions may be tax-deductible depending upon income level or participation in another qualified retirement plan; earnings are tax-deferred.

 insured the person who is covered by an insurance policy. In Life Insurance, the person whose life is insured by the policy.

 insurer an organization or company that assumes a risk to provide payment of a benefit, in exchange for premium payment(s).

 investment vehicle a trust or mutual fund that manages a collective group of participants' capital. Such a vehicle may have varying degrees of risk, with the least risk as the protection of capital and guaranteeing a fixed rate of investment return.

 IPA see "individual practice association"

IRA see "individual retirement account"

 life event (change in family status) as defined by the Internal Revenue Code, an event that permits a change in coverage in the middle of a plan year. The most common forms of a life event are marriage or divorce, birth or adoption of a child, disability or death of a dependent, or change in employment of the participant or spouse.

 lump sum a single payment of the entire value of a benefit, (contrasted to an annuity.)

non-contributory the employer pays the entire cost of the benefit plan.

 normal retirement date the earliest date at which an employee can receive a full retirement benefit. Under the Institution's Retirement Plan, this is the first of the month coincident with or following the attainment of age 65.

 occasional absence (for the Institution specifically) paid absence in the event of short-term illness or injury, or to be used for health care appointments or to care for birth, adoption or illness of a family member. Replaced sick leave. Refer to Institution's Personnel Practices and Procedures for details.

 open enrollment [period] a specified period of time during which eligible participants are allowed to make changes in their coverage in a benefits plan. This may be in a health, life insurance, or flexible spending account plan.

 out-of-pocket expense the cost for services that a participant must pay. This may include a deductible or copayments. Generally, it does not include "penalties" paid by a participant.

 participating provider a physician or other health care provider who has an agreement to provide services to participants in a plan.

PCP see "primary care physician"

 per capita fixed rate typically, a fixed premium that is based upon the number of covered individuals. This differs from an age-related or salary-related rate.

 PPO see "preferred provider organization"

 preferred provider organization (PPO) A group of physicians and other health care providers that contract to provide services on a discounted fee-for-service basis. Costs (to participants or employers) are usually lower than a fee-for-service indemnity plan.

primary care physician (PCP) a family practioner, internist, obstertrician-gynecologist, or pediatrician who provides routine medical care, with referral to specialists.

 proof of insurability certification by a qualified physician that a participant is without excessive health risk, for obtaining either health or life insurance coverage. Also, known as "evidence of good health."

provider a person or organization that furnishes service or care, e.g. a physician or nurse

 qualified individual.
 
 

• ADA a person with a disability, as defined under the provisions of the ADA, who is sufficiently able to perform the required duties of the job, currently held or desired.

 
• COBRA a person, whether the covered employee or dependent(s), who becomes entitled to elect the continuation of health coverage under the provisions of the federal law known as COBRA. This differs slightly from a covered individual or a beneficiary of the plan.

• COBRA the event, such as termination of employment or reaching the age of maturity, that causes a covered participant to the right to elect continuation of coverage.

 
• flexible benefits an event, as defined under Section 125 of the Internal Revenue Code, that permits a change in participation in the benefit plan outside of the open enrollment period.

 reimbursement account see "flexible spending account"

replacement income (for retirement plans) the ratio of benefit income at the time of electing retirement compared to one's final pay. Total replacement income is comprised of employer and employee contributions, and social security retirement benefits. The desired ratio to maintain the same standard of living during retirement is approximately 70% to 90%.

 rollover

• leave [balance] the act of "carrying" an accumulated balance of leave time from one plan year to the next year.

 
• retirement funds the act of transferring a retirement account or balance into either another retirement plan or individual retirement account (IRA) within 60 days to avoid incurring a tax liability.

sick leave see "occasional absence"

SPD see "summary plan description"

 summary annual report (SAR) a brief report of the financial status of benefit plan(s) that must be given to participants each year.

summary plan description (SPD) a statement to participants that summarizes the provisions of a plan in an easy-to-read format. It includes descriptions of eligibility, coverage, employee rights, and procedure for appeals.

supplement in addition to a benefit. This differs from coordinate in that a benefit recipient may exceed a plan's stated maximum benefit.

tax-deferred when a tax liability is postponed. This differs from tax-free.

 tax-deferred annuity (TDA) the purchase of a right to future periodic payments by the reduction of current compensation. Institution employees can do this through the 403(b) plan.

 tax-free without current or future tax liability.

 TDA see Tax Deferred Annuity

third-party administrator (TPA) A company, other than the employer, that handles the administration and claims processing of a benefit plan.

 TPA see "third-party administrator"

 vendor an outside company that will provide a benefit, or service of a benefit, for a fee.

vested entitled to a benefit. May either be immediately or after a certain period of employment or participation in a benefit plan.

 viatical settlement when an insured suffering from a life-threatening illness or injury "sells" her/his life insurance policy for a percentage of the face value of the policy(ies).

 waiver of premium when an insured continues to be covered under the same provisions, but is no longer required to pay the premium. This is common for disability income or life insurance coverage when the covered individual is totally or permanently disabled.