Open Enrollment Terminology Glossary

The maximum amount a health plan will pay for a covered service. If your provider charges more than the allowed amount, you may be responsible for the difference, depending on your plan and whether the provider is in-network.

A federal law that established standards for health insurance coverage, including affordability requirements and preventive care coverage.

A tool that helps determine whether your spouse's employer-sponsored health coverage meets the Affordable Care Act (ACA) affordability standard. Under the UVA Health Plan, if your spouse has access to employer-sponsored coverage that meets both the ACA affordability and minimum value standards, they are generally not eligible to enroll as a dependent on the UVA Health Plan. The calculator estimates whether your spouse's available coverage is considered affordable based on federal guidelines.

The person or people you designate to receive certain benefits, such as life insurance proceeds, after your death.

The benefits you choose to enroll in during Open Enrollment.

The percentage of the cost of a covered service that you pay after you've met your deductible.

Major dental procedures, such as crowns, bridges, dentures, and other treatments that restore damaged or missing teeth. The Basic and Enhanced Dental Plans cover these services at different levels.

A fixed dollar amount you pay for certain covered services, such as a doctor's office visit or prescription.

The portion of health care costs you pay through premiums, deductibles, copays, and coinsurance.

Health care services and supplies that are eligible for payment under your health plan.

The amount you pay for covered health care services before your health plan begins sharing the cost.

In-network preventive services, such as annual physicals and recommended screenings, that are covered at no cost to you without having to meet your deductible.

An eligible family member, such as a spouse or child, who may be covered under your health plan.

Health information that may be required before certain insurance coverage or increased coverage amounts can be approved

A tax-advantaged account that lets you set aside pre-tax money to pay for eligible health care or dependent care expenses. FSA elections typically must be made each year.

Lower-cost versions of brand-name prescription medications that contain the same active ingredients and are equally safe and effective.

One of the available medical plans you can choose during Open Enrollment. While plan options may cover the same health care services, they often differ in how costs are shared.

A tax-advantaged savings account available with eligible high-deductible health plans that can be used to pay for qualified health care expenses.

Doctors, hospitals, pharmacies, and other providers that have contracted with your health plan to provide services at negotiated rates.

A federal standard that determines whether an employer-sponsored health plan provides a minimum level of coverage.

Brand-name prescription medications that may be covered by the health plan but are not included on its preferred drug list. These medications typically cost more than preferred brand drugs.

The annual period when eligible employees can enroll in benefits or make changes to their benefit elections for the upcoming plan year.

Providers who do not have a contract with your health plan. Receiving care out of network may result in higher costs or reduced coverage.

The most you'll pay during a plan year for covered in-network health care costs. After reaching this limit, your health plan pays 100% of covered in-network expenses for the remainder of the year.

The period during which your benefit elections are in effect, typically January 1 through December 31.

The amount you pay from each paycheck to have health insurance coverage.

Routine health care, such as annual checkups, immunizations, and recommended screenings, that helps prevent illness or detect health conditions early.

The automatic amount deducted from your paycheck to pay your share of your benefit premiums.

Brand-name prescription medications that are included on your health plan's preferred drug list. These medications typically cost less than non-preferred brand drugs.

A major life change—such as marriage, divorce, birth, adoption, or loss of other coverage—that may allow you to change your benefits outside of Open Enrollment.

To decline enrollment in a benefit option for the upcoming plan year.