Glossary
Active
Means a scheduled work day in which you are performing work or are on a scheduled vacation. You are not considered an active employee if you are on any form of Leave of Absence.
After-Tax Dollars
Income from which federal, Social Security (OASDI/Medicare tax), state and local taxes have already been deducted.
Annual Contribution
The amount of earnings you may allocate to a benefit in any one period of time. For the purposes of the HRA and FSA the annual contribution is set by the IRS and applies to a calendar year (Jan. 1 to Dec. 31).
Annual Deductible
The amount you pay for covered services each plan year before the plan starts to pay for certain benefits.
Before-Tax Dollars
Income on which, under current law, you pay no federal income or Social Security (OASDI/Medicare tax) taxes. In many states, you pay no state or local taxes on before-tax dollars either.
Coinsurance
Coinsurance is a shared cost between what you pay for covered services after you satisfy your deductible and what the Plan pays on your behalf.
Copay
A copay is a flat amount that you pay for covered services.
Date of Service
Date of service accounts for active employment time only.
Evidence of Insurability (EOI)
Document required for enrolling or increasing Life insurance when medical underwriting is required. This is typically an online questionnaire; however, depending on your answers, additional information may be required, including a doctor’s response.
Guarantee Issue
The maximum amount of Life coverage guaranteed to be issued if elected at your first offering.
Incurred Expense
An expense is incurred when the service that gives rise to the expense has been provided, not when you are billed or when you pay the expense.
In-Network
Service paid for when participants use providers and facilities that are in the Plan’s network. These providers and facilities have contractual discounted rates with the carrier.
Inpatient
A person who receives medical treatment or services requiring one or more overnight stay(s) in a hospital or other approved care facility.
Maximum Annual Out-of-Pocket Limit
The most you will have to pay for covered medical expenses in a year, after premiums. Monies paid by the participant for noncompliance penalties or provider charges that are in excess of the maximum reimbursable charges are not included in calculating the maximum annual out-of-pocket limit.
Network Area
A geographical area in which the Medical/Dental/Vision networks are available to participants.
Network Providers
Physicians, hospitals, dentists and other healthcare providers located in network areas that participate in the Medical/Dental/ Vision Networks.
Out-of-Network Benefits
The benefits which are available to participants when they use out-of-network providers that are subject to deductibles, coinsurance and usual, customary and reasonable (UCR) benefits levels.
Out-of-Network Providers
Physicians, hospitals or other healthcare providers who do not participate in the network.
Outpatient
Treatment including services, supplies and medicines provided and used at a hospital under the direction of a physician to a person not admitted as a registered bed patient; or services rendered in a physician’s office, laboratory or X-ray facility, an ambulatory surgical center, or the patient’s home.
Pharmacy
A licensed establishment where covered prescription drugs are filled and dispensed by a pharmacist licensed under the laws of the state where he or she practices.
Physician
A person licensed, and acting within the scope of that license, to practice medicine or perform surgery.
Employee Classification
A regular employee works directly for Arapahoe County through W2 qualified earnings. Grant Funded employees are considered employees of the County but paid for out of grant funds. Temporary employees (intended to work on projects lasting less than one year at no more than 29 hours per week), contractors and seasonal employees are not eligible for Arapahoe County benefits, unless otherwise required by law.
Social Security Wage Base
Social Security’s Old-Age, Survivors and Disability Insurance (OASDI) program limits the amount of earnings subject to taxation for a given year. The same annual limit also applies when those earnings are used in a benefit computation. This limit could increase each year with increases in the national average wage index. We call this annual limit the contribution and benefit base. For earnings in 2021, this base is $141,900.
Usual, Customary and Reasonable (UCR-Specific to Arapahoe County Government Plans)
The amount paid for a medical service in a geographic area based on what 90% of providers in that area usually charge for the same or similar medical service. The UCR amount is used when non-emergency treatment is sought at an out-of-network provider or facility. The Plan will pay the out-of-network coinsurance amount based on the UCR rate, and the member will be responsible to pay their provider for any difference between the originally billed amount and the UCR.