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The following list contains words you may see used on the Federal Benefits Programs website. If you do not see the word you are looking for, please email us at firstname.lastname@example.org and ask us to add it to the glossary.
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A survey that asks questions to evaluate members' satisfaction with their health plans.
When you or a family member have more than one insurance plan covering the same benefits, one plan normally pays its benefits in full as the primary payer (see definition) and the other plan(s) pays a reduced benefit as the secondary payor (see definition). Payment is coordinated under the COB rule to ensure that no more than 100% of any claim is paid by both plans.
Medicare related - If you and/or your family member are covered under both Medicare and FEHB, Medicare makes the final determination as to whether they are the primary payor.
See Section 9 (Coordinating benefits with other coverage) of your FEHB brochure.
If you and/or your family member are covered under both an FEHB plan and a FEDVIP plan, the FEHB plan is considered the primary payor and pays first, while the FEDVIP plan is considered the secondary payor. If you are enrolled in a High Deductible Health Plan (HDHP), your FEDVIP plan is considered the primary payor and the HDHP is considered the secondary payor.
Healthcare Effectiveness Data and Information Set (FEHB). A set of health plan performance measures that center on how the plan performs in preventing and treating common conditions (e.g., cervical cancer screening, prenatal care, diabetes care) that reflect a plan's quality of care and services. The National Committee for Quality Assurance (NCQA) requires HEDIS and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accepts HEDIS in accrediting health plans.
Provides comprehensive coverage for high-cost medical events and a tax-advantaged to help you build savings for future medical expenses. The HDHP/HSA or HRA gives you greater flexibility and discretion over how you use your health care benefits.
The HDHP features higher annual deductibles (a minimum of $1,250 for Self and $2,500 for Self and Family coverage) than traditional health plans. The maximum amount out-of-pocket limits for HDHPs participating in the FEHB Program for Self and for Self and Family enrollments are based on IRS rules. With the exception of preventive care, you must meet the annual deductible before the plan pays benefits. Preventive care services are generally paid as first dollar coverage or after a small deductible or copayment. A maximum dollar amount may apply.
When you enroll in an HDHP, the health plan determines if you are eligible for a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). Each month, the plan automatically credits a portion of the health plan premium into your HSA or HRA, based on your eligibility as of the first day of the month. You can pay your deductible with funds from your HSA or HRA. If you have an HSA, you can also choose to pay your deductible out-of-pocket, allowing your savings account to grow.
If you are enrolled in a FEDVIP plan and you have a High Deductible Health Plan (HDHP), your FEDVIP plan is considered the primary payor and the HDHP is considered the secondary payor.
An open enrollment period held every year from the Monday of the first full work week in November through Monday of the first full work week in December when individuals eligible for the FEHB Program, FEDVIP, and FSAFEDS can enroll, or if already enrolled, change their enrollment.
The order of precedence does not apply when you have assigned your insurance or when a valid court order is on file.
A product offered by an HMO (see definition) or FFS (see definition) plan that has features of both. In an HMO, the POS product lets you use providers who are not part of the HMO network. However, there is a greater cost associated with choosing these non-network providers. You usually pay deductibles and coinsurances that are substantially higher than the payments when you use a plan provider. You will also need to file a claim for reimbursement, like in an FFS plan. The HMO plan wants you to use its network of providers, but recognizes that sometimes enrollees want to choose their own provider.
An annuitant, survivor annuitant, or former spouse covered under the Spouse Equity provision of FEHB law may suspend their FEHB enrollment in order to enroll in a Medicare Advantage plan (Medicare Part C), TRICARE, CHAMPVA, Medicaid or a similar state-sponsored program of medical assistance for the needy, or use Peace Corps health insurance coverage, but still retain the right to reenroll in FEHB. Please visit www.medicare.gov for more information.
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