Glossary

Biometric Measurements

A wellness screening during which your body mass index (BMI), blood pressure, cholesterol and glucose levels are measured to help you manage your health.

Brand Name Drug

A drug that is patented and produced only by one manufacturer.

Care Management

A system to ensure that you receive appropriate, reasonable health care services.

Centers of Excellence (COEs)

Centers of Excellence (COEs) are leading treatment centers that have been identified by UHC as using evidence-based, quality-of-care protocols to help deliver care for complex medical issues and procedures, such as fertility, spine & joint treatment, orthopedic issues, among others.

COBRA

A federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay 100% of the premiums, including the share GT used to pay, plus a small administrative fee.

Coinsurance

Money that you are required to pay for services, after you have met your deductible. Coinsurance is often specified by a percentage. For example, in the Tiered PPO Plan, you pay 20% toward the charges for an office visit and the plan pays 80%.

Contribution

The amount you pay out of your paycheck each month for health care coverage.

Copay

Copay is a predetermined (flat) fee that you pay for health care services, in addition to what the plan covers. For example, in the Network Plan, you pay a $30 copay for physician charges related to a Primary Care office visit.

Coverage Level

The level of coverage that determines your employee contribution amount for medical and dental coverage. Levels include Employee Only, Employee + Spouse/Same-Sex Partner, Employee + Child(ren) and Employee + Family.

Critical Illness Insurance

The voluntary critical illness insurance benefit pays you a lump-sum amount of either $5,000, $15,000 or $25,000 if you are diagnosed with certain serious medical conditions like heart attack, stroke or cancer.

Deductible

The deductible is the amount you must pay for health care expenses before the plan covers the costs.

Dependent

A dependent is a person covered by your benefit elections and may include your legal spouse and/or unmarried children through the end of the calendar year in which they attain age 26.

Dependent Care Flexible Spending Account (DCFSA)

A plan that allows you to set aside pre-tax contributions from your paychecks to pay the cost of care for eligible dependents.

Employee Assistance Program (EAP)

An employment-based plan designed to help you cope with issues such as work/life balance, stress, family violence and grief. The plan offers employees counseling assistance by telephone, and may also cover follow-up visits with counselors if needed.

Exclusive Provider Organization (EPO)

A managed care plan where services are covered only if you go to doctors, specialists or hospitals in the plan’s network (except in case of emergency). Other rules and restrictions apply in GT’s EPO, the Network Plan.

Explanation of Benefits

A written explanation regarding a claim, showing what insurance paid, what was applied to the deductible, if applicable, and your responsibility.

Flexible Spending Account (FSA)

A plan that allows you to set aside pre-tax dollars for common health care or dependent care expenses. You must use FSA funds by the end of the plan year or they will be lost.

Formulary

A list of drugs your insurance plan covers. It may include how much you pay for each drug. For example, in the Network Plan, the formulary lists the drugs in each tier. Formularies may include both generic drugs and brand name drugs.

Generic Drug

A drug that does not have the trademark of the original manufacturer. It is chemically identical to and generally costs less than its brand name counterpart.

Health Assessment

An interactive health questionnaire that can help you evaluate your health risks and quality of life.

Health Care Flexible Spending Account (HCFSA)

An account you may establish to set aside pre-tax contributions from your paychecks to pay eligible health care expenses.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

A federal law that allows you to qualify immediately for comparable health insurance coverage when you change your employment or relationships. It also creates the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care.

Health Savings Account (HSA)

A savings account with tax advantages that allows you to save for future health care expenses. Funds contributed to the account are not subject to federal income taxes at the time of deposit. Unlike Flexible Spending Accounts (FSAs), funds roll over and accumulate year-to-year. HSAs must be paired with an HSA-compatible high-deductible health insurance plan.

High Deductible Health Plan (HDHP)

A plan that features higher deductibles than traditional insurance plans. HDHPs can be combined with a Health Savings Account (HSA) to allow you to pay for qualified out-of-pocket health care expenses on a pre-tax basis.

In-Network

Refers to providers or health care facilities that, through contract negotiations, provide services at a lower cost to the plan and to you.

Lifetime Maximum Benefit

Maximum amount a health plan will pay in benefits to you during your lifetime.

Limited Purpose Health Care Flexible Spending Account (Limited Purpose HCFSA)

Allows you to set aside money for health care costs from your paycheck pre-tax. Medical expenses are ineligible until after you reach your medical plan deductible. After the deductible has been met, the Limited Purpose FSA works like a traditional Health Care FSA.

Long Term Care Insurance

Insurance that covers care and services in a variety of settings, including nursing homes, assisted living facilities and your home.

Long Term Disability Plan

A plan that pays you a percentage of your monthly earnings if you are unable to work due to an illness or injury for an extended length of time.

Managed Care

A medical delivery system that attempts to manage the quality and cost of medical services that you receive. Plans attempt to improve health quality by emphasizing wellness and preventive care.

Medicaid

Medicaid is a health insurance program for low-income individuals who cannot otherwise afford Medicare or other commercial health insurance plans. Medicaid is funded in part by the government and by the state where you live.

Medicare

Medicare is the federal health insurance program created to provide health coverage for Americans aged 65 and older and later expanded to cover younger people who have permanent disabilities or who have been diagnosed with end-stage renal disease or amyotrophic lateral sclerosis (ALS).

Out-of-Network

Refers to physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan. Expenses for services may not be covered, or covered only in part by the plan. Physicians not fully reimbursed by the plan may bill you for the balance of their fees.

Out-of-Pocket Maximum

A predetermined limited amount of money that you must pay before the plan pays 100% of your eligible expenses.

Patient Protection and Affordable Care Act (PPACA)

Also known as the Affordable Care Act or ACA, this is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The legislation includes a long list of health-related provisions that began taking effect in 2010.

Preferred Provider Organization (PPO)

A managed care organization of health providers who contract to provide health insurance coverage at substantial discounts to you. If you use a provider within the PPO network, you may pay less for your care.

Qualified Life Event

Qualified life events are specific life changes that allow you by law to modify your healthcare benefits outside of GT's Annual Enrollment period. Examples include:

• Marriage
• Divorce
• Birth of a child
• Change in benefits eligibility status, such as the loss of a spouse's job.

Your request to modify your benefits must be initiated within 30 days of the event occurrence and done via myGT. Supporting documentation is required for the event to be approved, and should be forwarded in a timely manner.

The benefit changes you make must correspond to the life event. For instance, if you get married or divorced, you can add or remove your new or former spouse, but you can't switch from the Network Plan to the Tiered PPO Plan.

Short Term Disability Plan

Pays a percentage of your weekly earnings if you are unable to work due to illness or injury lasting longer than 13 days (the elimination period).

Specialty Drug

High-cost prescription medication used to treat complex, chronic conditions like rheumatoid arthritis, multiple sclerosis and cancer. These medications often require special handling and administration.

Telemedicine

A unique benefit that enables you to connect with a Board-certified physician for certain minor medical conditions, such as a sore throat, migraine or sinus problem, using your phone, computer or tablet.

Tobacco-Free

If you have not smoked, chewed or in any manner used tobacco products of any kind including, but not limited to, cigarettes, pipes, hookahs, cigars, snuff, dipping tobacco, chewing tobacco or other smokeless tobacco products in the most recent six-month period, you are considered tobacco-free.

Urgent Care Provider

A provider that performs services for health problems that require immediate medical attention but are not life-threatening emergencies.

Usual, Customary & Reasonable (UC&R)

An amount customarily charged for or covered for similar services and supplies that are medically necessary, recommended by a doctor or required for treatment.