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Evidence of Insurability (EOI)—information you provide to the Preventive Care—services
insurance carrier to prove you are in good health. EOI may be required and screenings that provide
for certain amounts of voluntary life insurance where elected coverage early detection and intervention
amounts are above the guaranteed issue amount. EOI may also be of healthcare issues. Most in-
required for disability coverage. network preventive care services
are covered at 100 percent in the
Explanation of Beneits (EOB)—a form that is sent to you each time low deductible plan and all are
a claim is processed. The EOB form is used to help you understand how covered at 100 percent in the high
your beneits are being applied. The EOB is not a bill but a management deductible plan.
tool you can use to compare with the provider’s statement or receipt.
Reasonable and Customary—
Formulary—a list of preferred drugs, both generic and brand-name sometimes called “Usual and
medications, that are considered cost-effective by a particular health Customary,” this term applies
provider. Medications on the preferred-drug list have been approved by to the prevailing charge for a
the FDA as safe and effective. healthcare service or supply
offered by similar providers within
Generic Drug—a prescription drug that is not a brand-name but has the the same geographic area, in the
same active-ingredient formula as the brand-name drug. absence of insurance. A plan may
Guaranteed Issue (GI)—the amount of coverage an applicant may elect not cover the part of the charge
and receive without furnishing EOI. that is above the reasonable and
customary level.
Healthcare Flexible Spending Account (HFSA)—this account
allows participants to allocate pretax dollars to pay for eligible healthcare Specialist or Medical
expenses that are not covered by their healthcare plans. Examples of Specialist—medical specialists
eligible expenses include copays, deductibles, certain over-the-counter are doctors who have completed
drugs and LASIK surgery. See IRS Publication 502 at www.irs.gov for advanced education and clinical
more information. training in a speciic area of
medicine (their specialty area).
Preferred Provider Organization (PPO)—a PPO health plan is made There are 26 recognized medical
up of a network of hospitals, physicians and other service providers that specialties in the US.
are contracted by an insurance company and agree to offer members
discounted services. A passive PPO health plan allows participants to see Specialty Drug—specialty or
the provider of their choice, but their out-of-pocket costs may be lower if biotech drugs are genetically
they receive services from network providers. engineered compounds designed
to target and treat speciic diseases.
Benefit Guide 2016
Evidence of Insurability (EOI)—information you provide to the Preventive Care—services
insurance carrier to prove you are in good health. EOI may be required and screenings that provide
for certain amounts of voluntary life insurance where elected coverage early detection and intervention
amounts are above the guaranteed issue amount. EOI may also be of healthcare issues. Most in-
required for disability coverage. network preventive care services
are covered at 100 percent in the
Explanation of Beneits (EOB)—a form that is sent to you each time low deductible plan and all are
a claim is processed. The EOB form is used to help you understand how covered at 100 percent in the high
your beneits are being applied. The EOB is not a bill but a management deductible plan.
tool you can use to compare with the provider’s statement or receipt.
Reasonable and Customary—
Formulary—a list of preferred drugs, both generic and brand-name sometimes called “Usual and
medications, that are considered cost-effective by a particular health Customary,” this term applies
provider. Medications on the preferred-drug list have been approved by to the prevailing charge for a
the FDA as safe and effective. healthcare service or supply
offered by similar providers within
Generic Drug—a prescription drug that is not a brand-name but has the the same geographic area, in the
same active-ingredient formula as the brand-name drug. absence of insurance. A plan may
Guaranteed Issue (GI)—the amount of coverage an applicant may elect not cover the part of the charge
and receive without furnishing EOI. that is above the reasonable and
customary level.
Healthcare Flexible Spending Account (HFSA)—this account
allows participants to allocate pretax dollars to pay for eligible healthcare Specialist or Medical
expenses that are not covered by their healthcare plans. Examples of Specialist—medical specialists
eligible expenses include copays, deductibles, certain over-the-counter are doctors who have completed
drugs and LASIK surgery. See IRS Publication 502 at www.irs.gov for advanced education and clinical
more information. training in a speciic area of
medicine (their specialty area).
Preferred Provider Organization (PPO)—a PPO health plan is made There are 26 recognized medical
up of a network of hospitals, physicians and other service providers that specialties in the US.
are contracted by an insurance company and agree to offer members
discounted services. A passive PPO health plan allows participants to see Specialty Drug—specialty or
the provider of their choice, but their out-of-pocket costs may be lower if biotech drugs are genetically
they receive services from network providers. engineered compounds designed
to target and treat speciic diseases.
Benefit Guide 2016
