| Term |
Definition |
AD&D
|
Accidental Death and Dismemberment |
| Beneficiary |
A person designated by a plan participant or by the
terms of an insurance plan, who is or may become entitled
to a benefit. |
| Carrier |
An organization, such as an insurance company, that
provides or administers programs that arrange for health,
dental, life or other insurance services. |
| COBRA |
Consolidated Omnibus Budget Reconciliation Act: a federal
law that, among other things, requires employers to offer
continued health insurance coverage to certain employees
and their beneficiaries whose group health insurance has
been terminated if they undergo a qualifying event. |
| Deductible |
The amount of eligible expenses a covered person must
pay each year from his/her own pocket before the plan
will make payment for eligible benefits. |
| Dependent |
A covered person who relies on another person for support
or obtains health coverage through a spouse or parent
who is the covered person under a plan. |
| DE 6 |
Quarterly Wage report that the Employer must file with
the government |
| Effective Date |
The date insurance coverage begins. |
| Employee Census |
List of employees and their pertinent information: ID
#, social security number & date of birth. |
| Enrollee |
An Employee or their Dependent who is enrolled to receive
benefits, or an Individual who chooses to pay for Optional
Continuation of Coverage through COBRA. |
| EOC |
Evidence of Coverage |
| GSR |
CoPower Group Service Representative. |
| Loss of Coverage |
When coverage is no longer in effect. |
| Maximum |
The greatest dollar amount a carrier will pay for covered
procedures in any calendar year |
| Open Enrollment |
There are three types of open enrollment:
1.The period during which participants in a benefit
program have an opportunity to choose among health or
dental plans being offered to them.
2.An employer is able to change their benefits on their
anniversary.
3. Late enrollees can come onto a plan during their
anniversary (only available in select CoPower plans). |
| Premium |
The cost of insurance coverage for a specified benefit
over a specific time period. |
| Proof of Loss of Coverage |
Documentation indicating the reason for a loss of coverage. |
| Qualifying Event |
An event that may entitle a person to continue insurance
coverage or allow an employee or dependent to come onto
a plan after their eligibility has expired. Examples of
qualifying events include termination of employment, loss
of coverage, reduction in work hours, death of an insured
employee, divorce or legal separation, a dependent child’s
loss of dependent status, birth of a child, adoption or
marriage. |
| Remittance Report |
A CoPower form the Employer uses to indicate changes
in an Employee's coverage. It should be sent to CoPower
as soon as possible, but no later than 30 days after the
change. |
| UCR |
Usual, customary and reasonable charges as compared
to charges for like treatment, services and supplies in
the geographic area where treatment is performed. |
| 1099 Employees |
Contract Employees |
