- Accidental Death & Dismemberment (AD&D) Coverage
- Beneficiary
- Brand-name Drugs
- COBRA - Consolidated Omnibus Budget Reconciliation Act of 1985
- Coinsurance
- Copayment
- Domestic Partner
- Deductible
- Exclusive Provider Organization (EPO)
- Explanation of Benefits (EOB)
- Formulary Drug
- Generic Drug
- In-Network Provider
- Long-Term Disability (LTD)
- Non-Formulary Drug
- Open Enrollment
- Out-of-Network Provider
- Out-of-Pocket Maximum
- Preferred Provider Organization (PPO)
- Qualifying Life Events
- Short-Term Disability (STD)
- Waiving Medical Coverage
Accidental Death & Dismemberment (AD&D) Coverage :
Insurance that pays money (pays a benefit) to a beneficiary if an accident
causes the death of the insured person. A benefit may also be payable
for the accidental loss of limb, sight, hearing and/or speech.
Beneficiary :
The person(s) named by you to receive any benefits provided by a Life
Insurance and/or AD&D plan if you die. Benefits will be paid to
the primary beneficiaries unless they have died before or at the same
time or are unavailable. In this case, benefits will be paid to the
contingent beneficiaries.
Brand-Name Drug:
Drugs developed and produced exclusively by a single pharmaceutical
company. The formula for these drugs is protected by patent for a period
of several years before a generic can be developed.
COBRA - Consolidated Omnibus Budget Reconciliation Act of 1985
:
Provides an opportunity for postdocs to temporarily continue health
care coverage in a sponsored plan after their coverage normally would
have terminated. The federal law allows postdocs leaving Stanford to
continue the health insurance coverage they had when on assignment
as a postdoc. You pay group premium rates plus a set administrative fee.
Visit our Leaving Stanford page for more information on COBRA.
Coinsurance:
The percentage of the allowable amount or billed charges that the member must pay for covered services after meeting any applicable plan deductible.
Copayment:
The fixed dollar amount the member must pay covred services after meeting any applicable plan deductible.
Domestic Partner:
Postdoc’s domestic partner under a legally registered and valid domestic partnership. Domestic partner does not include any person who is: (a) covered as an insured employee; or (b) in active service in the armed forces.
For a domestic partnership, other than one that is legally registered and valid, in order for the Postdoc to include their domestic partner as a family member, the Postdoc and domestic partner must meet the following requirements:
a. Both persons share a common residence.
b. Neither person is married to someone else or a member of another domestic partnership with someone else that has not been terminated, dissolved, or adjudged a nullity.
c. The two persons are not related by blood in a way that would prevent them from being married to each other in California, or if they reside in another state or commonwealth, that state or commonwealth;
d. Both persons are at least 18 years of age.
e. Either of the following:
i. Both persons are members of the same sex; or
ii. One or both of the persons meet the eligibility criteria under Title II of the Social Security Act as defined in 42 U.S.C. Section 402(a) for old-age insurance benefits or Title XVI of the Social Security Act as defined in 42 U.S.C. Section 1381 for aged individuals. Notwithstanding any other provision of this section, persons of opposite sexes may not constitute a domestic partnership unless one or both of the persons are over the age of 62.
f. Both persons are capable of consenting to the domestic partnership.
g. Both partners must provide postdoc benefits with a signed, notarized, affidavit certifying they meet all of the requirements set forth in 2.a through 2.f above, inclusive.
As used above, "have a common residence" means that both domestic partners share the same residence. It is not necessary that the legal right to possess the common residence be in both of their names. Two people have a common residence even if one or both have additional residences. Domestic partners do not cease to have a common residence if one leaves the common residence but intends to return.
Deductible :
The amount you must pay out-of-pocket before benefits are paid. The
amount is usually an annual amount.
Exclusive Provider Organization (EPO):
The Blue Shield EPO plan covers care, including preventive visits, lab work, and specialist services, only when rendered by a provider in the Blue Shield network. The EPO plan does not cover you for non-network care except for emergencies. Unlike a PPO plan, all services are covered after a copay. There are no deductibles or coinsurance. Pre-authorization for certain procedures and treatments is required.
Explanation of Benefits (EOB) :
The statement sent to you by your health plan explaining the benefit
calculation and payment of medical services that details the services
rendered and the benefits paid or denied for each service. An EOB lists
the charges submitted, the amount allowed, the amount paid and any balance
owed as the patient's responsibility.
Formulary Drug:
List of prescription drugs approved for a health plan's prescription
drug benefit. Formulary lists are available at Anthem's website
or you can call Anthem's Customer Service number and request a copy.
Generic Drug :
A prescription drug that is chemically equivalent to a brand name drug
dispensed under its generic chemical name. Generic drugs are cheaper
versions of expensive brand name drugs with the same active ingredients,
strength and dosage form.
In-Network Provider :
A doctor, dentist, hospital or other practitioner who has a contract
with a health plan to provide services.
Long-Term Disability (LTD) :
A disability lasting more than 90 days.
Non-Formulary Drug :
Any brand-name prescription drug that is not included in a particular
health plan's list of approved formulary drugs.
Open Enrollment :
The time period each year (usually in November) when you have an opportunity
to change your benefit elections. Examples of changes: switch from HMO
to PPO or PPO to HMO; add dependent(s) to medical/dental if not enrolled
in your plan. Changes you make during Open Enrollment take effect the
following January 1.
Out-of-Network Provider :
A doctor, dentist, hospital or other practitioner who does not have
a contract with a health plan.
Out-of-Pocket Maximum :
A dollar limit on the total amount that a member has to pay for many covered services in a calendar year, including the copayments, coninsurance, and deducitble.
Preferred Provider Organization (PPO) :
A PPO is a network of doctors and hospitals that contracted with a health
plan and have agreed to provide their medical services at rates lower
than their standard fees. A PPO offers both in-network and out-of-network
benefits.
Qualifying Life Events :
When changes happen in your work or personal life, your benefits may
need to change too. If you’re eligible to make changes, you must
make the change within 31 days of the date of your qualifying life event
(e.g., gain a dependent child through birth, adoption or legal custody,
spouse/partner loses coverage due to loss of job and now needs coverage
through you). If you miss the 31-day deadline, you will have to wait
until the next open enrollment period held typically in November.
Short-Term Disability (STD) :
A disability lasting less than 181 days.
Waiving Medical Coverage :
Stanford University requires that all postdoctoral scholars be covered
by medical insurance. Some postdocs choose to waive the benefits offered
through the Postdoctoral Services Office. Waiving the medical,
dental and/or vison benefits means that you relinquish your option to enroll in the
medical, dental and vision benefit plans offered through the postdoc benefits
and obtain coverage through a different source (e.g.,
coverage through spouse/partner, individual policy). In order to waive
medical coverage, you are required to sign a Waiver
Form within 31 days of your appointment start date; otherwise your
department will be charged for your medical coverage.
*updated 2/16/12