Glossary of Health Care Terms


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.

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Brand-Name Drugs :
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.

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Copayment :
Amount(s) paid to a health care provider at the time service is rendered.

Domestic Partner :
Stanford University Postdoctoral Services Office defines Domestic Partner as the partner of an eligible postdoc who is of the same sex or opposite sex, sharing a long-term committed relationship of indefinite duration. The domestic partnership must be an exclusive mutual commitment similar to marriage and in existence for at least six months. To enroll your same-sex or opposite sex domestic partner for benefits coverage, you must certify eligibility by completing the Affidavit of Domestic Partnership Form and submitting the form to the Postdoc Office.

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Deductible :
The amount you must pay out-of-pocket before benefits are paid. The amount is usually an annual amount.

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.

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Formulary :
IList of prescription drugs approved for a health plan's prescription drug benefit. Formulary lists are available at CIGNA’s web site or you can call CIGNA’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.

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HMO (Health Maintenance Organization) :
Health care delivery system that typically uses contracted primary care physicians to coordinate all health care for enrolled members. HMOs require you to select a primary care physician (PCP). The PCP coordinates your care and refers you to specialists and hospitals. Covered services are usually paid in full after you pay any required copayment. No claim forms are required. An HMO option does not allow you to use providers outside of the HMO.

In-Network Provider :
A doctor, dentist, hospital or other practitioner who has a contract with a health plan to provide services.

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Long-Term Disability (LTD) :
A disability lasting more than 90 days.

Lucile Packard Children's Hospital :
A facility that specializes in the care of babies, children, adolescents, and expectant mothers and is located at 725 Welch Road Palo Alto, CA 94304. Packard Children's Hospital is part of Stanford Hospital and Clinics.

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Menlo Medical Clinic :
Menlo Clinic is a medical group of primary care physicians and specialists located at 1300 Crane Street, Menlo Park, CA 94025. Menlo Clinic is affiliated with Stanford Hospital & Clinics.

Non-Formulary Drug :
Any brand-name prescription drug that is not included in a particular health plan's list of approved formulary drugs.

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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.

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Out-of-Pocket Maximum :
The maximum dollar amount -including deductibles and copayments that you pay in any calendar year toward the cost of covered medical care. Once you reach your individual or family out-of pocket maximum, the health plan will cover your eligible services at 100% for the remainder of the calendar year. Prescription Drug copayments are not included in your out-of-pocket maximum dollar amount.

Palo Alto Medical Foundation (PAMF) :
Palo Alto Medical Foundation is a community-based, multi-specialty medical group practice that operates as a nonprofit organization. Locations include the Palo Alto Clinic in Palo Alto; Los Altos Center in Los Altos, Fremont Center in Fremont and the Women's Health Medical Group in Portola Valley. PAMF is affiliated with Sutter Health (a nonprofit network of physicians, hospitals and other community health care services).

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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.

Primary Care Physician (PCP) :
A physician in general practice or who specializes in pediatrics, family practice or internal medicine that has been selected by the covered individual from the list of primary care physician's in the Plan directory. CIGNA’s HMO plan requires a member to choose a PCP and to always see the PCP for a referral to a specialist.

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Primary Care Physician (PCP) ID Number :
The unique number assigned to each primary care physician (PCP) in the CIGNA network. PCP ID numbers are also available from CIGNA’s Customer Service department or from CIGNA’s website. When you enroll in the CIGNA HMO plan, you must designate a PCP, or you will be assigned a PCP by CIGNA. If you wish to change your PCP assignment, you must contact CIGNA's Customer Service department.

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 30 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 30-day deadline, you will have to wait until the next open enrollment period held typically in November.

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Short-Term Disability (STD) :
A disability lasting less than 90 days.

Stanford Hospital & Clinics :
SHC is part of the Stanford University Medical Center located at 300 Pasteur Drive, Stanford, CA 94305. Stanford Hospital & Clinics has a close relationship with both the Stanford University School of Medicine, and Lucile Packard Children's Hospital, an adjacent pediatric teaching hospital.

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 and/or dental benefits means that you relinquish your option to enroll in the medical and dental benefit plans offered through the postdoc office and obtain coverage through a different source (e.g., Cardinal Care, coverage through spouse/partner, individual policy). In order to waive medical coverage, you are required to sign a Waiver Form within 30 days of your appointment start date; otherwise your department will be charged for your medical coverage.