Benefits Glossary

A comprehensive review of an insurance company to ensure that all payments are correct and appropriate for legitimate expenses covered by the health plan. A Carrier Audit may be completed on both Fully and Self-Insured Plans to achieve plan efficiencies, ensure legal compliance, recover cash and eliminate future spending problems.

The process of comparing insurance carriers’ records of covered members to the employer/plan sponsor’s and/or administrator’s records to ensure accuracy and consistency of covered members, which ultimately leads to confirming accuracy of premiums and ASO fees.

Employee benefits and enrollment data that a plan sponsor provides electronically to an insurance company for open enrollment, life change events, new hires, terminations, and address and other changes to ensure the carrier has current and accurate information about plan members.

The process of comparing the insurance company’s records of premiums and payments to the employer plan sponsor’s records to ensure accuracy and consistency with the contract.

A plan category under the ACA that is a high-deductible health plan for people who are under age 30 or who qualify for a Hardship Exemption. The Premium amounts are generally lower, but the out-of-pocket costs for Deductibles, Co-payments and Coinsurance are generally higher.

A feature of 401(k) Plans, 403(b) Plans and most 457 Plans that permits an eligible employee who has attained age 50 to make a higher annual contribution to the plan. See also super catch-up contribution.

View current IRS limits for retirement plans.

Children’s Health Insurance Program acronym. Provides health coverage to low- and moderate-income children. It is jointly funded and administered by the states and the federal government. It was originally called the State Children’s Health Insurance Program (SCHIP).

Someone who processes claims for an insurance company or an independent claims adjudication facility. They investigate and negotiate claims filed by insurance policy holders. They verify eligibility for coverage and get claims paid – or find out why they have been denied. Also known as a Claims Adjuster.

A pension plan that is closed to new participants as of a specified date.

Centers for Medicare & Medicaid Services acronym. The federal agency that runs Medicare, Medicaid, the CHIP, and the Marketplace.

A fixed dollar amount—such as $25 for each doctor visit—that a covered plan member pays for medical services. Also referred to as Co-pay.

Consolidated Omnibus Reconciliation Act (COBRA) acronym. This law provides certain former employees, retirees, spouses, former spouses and dependent children the right to temporary continuation of health coverage at a former employer’s group rates for a limited period of 18 or 36 months. A plan may provide longer periods of coverage beyond the minimum period required by law.

A percentage of a health care cost—such as 20%—that a covered employee pays after meeting the deductible. Coinsurance rates may differ between services received from an approved provider and those received from providers not on the approved list.

A way of pricing insurance where every policyholder pays the same Premium, regardless of health status, age or other individual factors.

An adjustment (increase) made to a pension benefit payment in order to counteract the effects of inflation.

Health insurance coverage that meets a minimum set of qualifications. Types of Creditable Coverage plans include group health plans, individual health insurance, student health plans, as well as a variety of government-sponsored or government-provided plans.