COBRA

The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides employees who lose their health benefits the option to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. COBRA details how to obtain a temporary extension of health coverage (called continuation coverage) where coverage under the plan would otherwise end.

Coinsurance

The percentage you must pay after the yearly deductible has been met until the out-of-pocket maximum is reached.

Deductible

The amount you pay each year before the plan begins to pay for expenses.

Dependents

Eligible dependents include:

• Your lawful, opposite or same-sex spouse from a licensed marriage, registered common-law marriage or registered domestic partner relationship
• Your children from birth until the end of the month in which they turn age 26 (or age 30 for international employees). This includes a child (within the age requirements) for whom you have assumed guardianship responsibility as documented by a formal legal document or certified court order.
• Your unmarried (never married) dependent children who are not able to be employed due to a mental or physical handicap. These children are covered after reaching age 26 if they are dependent upon you for support and were incapacitated prior to the date on which insurance would have otherwise ended.
• Adopted children under age 26 or children placed for adoption with the employee in connection with adoption proceedings, if they are enrolled in the plan within 31 days of the adoption date.
• A dependent does not include anyone who is also enrolled as an employee.  No one can be a dependent of more than one employee.

Evidence of Insurability (EOI)

An application process in which you provide information on the condition of your health or your dependent’s health in order to be considered for certain types of insurance coverage. The completed EOI application requires review and approval before coverage becomes effective.

Health coaching

A coaching program administered to help you identify and change lifestyle habits that may be increasing your risk for chronic health problems.

In-network

When care is given by a participating provider, it is considered in-network. Staying in the network for care means you will be given the negotiated rate for the services provided.

Lifetime maximum

The maximum amount the plan will pay per covered member in his or her lifetime.

Out-of-network 

Any care received outside of the insurance provider network is considered out-of-network. You will not receive the negotiated rate and your share of the cost will be higher in most cases than in-network costs.

Out-of-pocket maximum

The limit to how much you have to pay out of your own pocket each year for covered health expenses. Once you reach this limit, the plan pays 100% of eligible costs for the rest of the year.

Registered domestic partner

An individual of the same or opposite sex with who you have established a domestic partnership. Both persons must:

• Not be so closely related that marriage would otherwise be prohibited
• Not be legally married to, or the domestic partner of, another person under either statutory or common law
• Be at least 18 years old and a registered domestic partner, living together and sharing the common necessities of life
• Be mentally competent to enter into a contract
• Be financially interdependent.

Registered common law marriage

Registered common-law marriage is defined by each state. For common-law spouse insurance under this plan, you will need to meet the definition of a common-law marriage for the state in which you reside. You must not be legally separated from your spouse and you must be registered with a state or local government common-law registry.

Spouse

Your lawful, opposite or same-sex spouse from a licensed marriage, common-law marriage or registered domestic partner relationship. Common-law marriage is defined by each state, and you will need to meet the definition of a common-law marriage for the state in which you reside. You must not be legally separated from your spouse.