A
Additional (Optional) Life Insurance - Also referred to as voluntary life insurance; Commonwealth of Massachusetts-sponsored Term Life and Accidental Death and Dismemberment Insurance, based upon a State Employee's annual compensation and age, for which State Employees and State Retirees pay the full premium cost and which is in addition to the Basic Life Insurance.
Annual Enrollment - The period in which eligible insured and uninsured persons may enroll themselves and their Dependents in the Commonwealth of Massachusetts benefit programs or make changes to their status or benefits in those programs that become effective on July 1st.
B
Basic Life Insurance - Commonwealth of Massachusetts-sponsored Term Life Insurance, for which eligible Employees and Retirees pay a portion of the premium cost and the Commonwealth pays an employer’s share.
Broad Network - A health plan that offers the widest selection of in-network providers, as well as out-of-network benefits in some cases (PPO and POS plans). This health plan also offers the fewest geographic service area restrictions.
C
Calendar Month - For the purpose of premium payments and Commonwealth of Massachusetts- coverage, a full month, e.g., March 1st through March 31st.
Consolidated Omnibus Budget Reconciliation Act (COBRA) - A federal law that allows enrollees to continue their health coverage for a limited period of time after their group coverage ends as the result of certain employment or life event changes.
Copay - A set dollar amount that is paid when you visit a provider (doctor’s office, hospital inpatient admission, etc.) or fill a prescription. Depending on what services are provided, the copay may be your only payment responsibility, or other services (such as blood work or treatments provided) may have costs that apply toward your deductible.
D
Dependent Care Assistance Program (DCAP) - A pre-tax benefit for state employees that allows participants to set aside a certain amount of their income annually to use to pay certain employment-related dependent care expenses, such as childcare or day camp for a dependent child under the age of 13 and/or a disabled adult dependent.
Deductible - A set dollar amount you are responsible for paying to your provider(s) for certain services before the plan will pay for these services. Deductibles reset each plan year. GIC medical plans have separate deductibles for medical and prescription benefits.
E
Employee Assistance Program (EAP) - The Mass4YOU EAP program offers work/life services to Commonwealth of Massachusetts employees eligible for GIC benefits and their dependents.
Elderly Governmental Retiree (EGR) - A state employee who retired from state service prior to January 1, 1956.
Employer Group Waiver Plan (EGWP) - An employer-sponsored Medicare Part D Prescription Drug Plan (PDP) with additional coverage provided by the GIC. This additional coverage means that you have more coverage than the standard Medicare Part D plan.
F
Flexible Spending Account (FSA) - An account that allows members to set aside money via pre-tax payroll deduction for use in paying for medical expenses (HCSA) or for childcare (DCAP). The rules governing these plans are set by the IRS, and any funds left over after the end of the plan year’s runout and filing date are forfeited.
Formulary - A formulary is a list of brand names and generic drugs covered by your prescription drug plan.
G
Group Insurance Commission Coordinator - GIC coordinators inform employees in their agencies about GIC benefits and help them enroll in, update, and process their GIC benefit selections. The person at each reporting location acts as a liaison between the reporting location and the Commonwealth of Massachusetts on matters involving the employer's and its employees' participation in the Commonwealth of Massachusetts programs.
H
Health Care Spending Account (HCSA) - A pre-tax benefit that allows state employees to contribute a set amount of their income for out-of-pocket health care expenses, such as copayments, deductibles, eyeglasses, and orthodontia.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) - The Federal law protects employees and their families health insurance coverage when they change or lose their jobs. It also requires the establishment of national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers. The law also addresses the security and privacy of health data.
Health Maintenance Organization (HMO) - A health plan that provides coverage for treatment by a network of doctors, hospitals, and other health care providers within a certain geographic area. HMOs do not offer out-of-network benefits, with the exception of emergency care. An HMO requires the selection of a Primary Care Physician (PCP).
I
Indemnity - A type of insurance that does not rely on a network of providers, but rather focuses on paying a set fee depending on the procedure, provider, or service rendered.
Income - Related Monthly Adjustment Amount (IRMAA) - A monthly additional fee imposed by Social Security on any Medicare beneficiary enrolled in Medicare Part B and/or Part D when it is determined that the member’s adjusted gross income, as reported on the federal tax return, exceeds a certain amount. Contact Medicare.gov for more information. Social Security will notify you if IRMAA applies to you.
L
Limited Network - A health plan that limits members to a smaller set of high-value providers (lower cost while maintaining quality) than a broad network plan, in exchange for lower premium costs.
Long Term Disability (LTD) - An income replacement program for active employees providing a tax-free benefit of up to 55% of salary if illness or injury renders them unable to work for longer than 90 days. Employees pay 100% of the premium.
N
National Network - A health plan that has a robust network of contracted in-network providers throughout the United States.
Networks - Groups of doctors, hospitals and other health care providers that contract with a benefit plan. If you are in a plan that offers both network and non-network coverage, you will receive maximum higher level of benefits when you are treated by network providers.
Nondiscriminatory Basis - Plans whose coverage does not contain any annual or lifetime dollar or unit of service limitation imposed for care provided by one type of participating provider that is less than any annual or lifetime dollar of unit of service limitation imposed on coverage for the same services by other types of participating providers.
P
PCP (Primary Care Physician) - Physicians with specialties in internal medicine, family practice, and pediatrics, as well as nurse practitioners and physician assistants who coordinate their patients' health care.
Plan Year - The 12-month period that encompasses a year of coverage or experience on any given insurance plan, or other GIC benefit. Almost all GIC insurance plans and programs use a plan year that matches the Commonwealth’s Fiscal Year, July 1 – June 30.
Portability - Allows active employees who end employment with the Commonwealth to continue life insurance coverage at the same level of coverage. The premium for the portable life insurance coverage will be at the same rates you are insured for under the Commonwealth's group plan. Certain coverage and time limits apply.
POS (Point of Service) - A health plan that provides coverage for treatment by a network of doctors, hospitals, and other health care providers. Selection of a Primary Care Provider (PCP) is required. To get the lowest out-of-pocket cost, a member must utilize in-network providers and receive referrals for specialists.
Preferred Provider Organization (PPO) - A health insurance plan that offers coverage by network doctors, hospitals, and other health care providers, but also provides a lower level of benefits for treatment by out-of-network providers. A PPO plan encourages the selection of a Primary Care Provider (PCP) but does not require one.
Preventive Services - Generally, health care services, such as routine physicals, that do not treat an illness, injury, or a condition, and are commonly free of charge to members (as mandated by the Affordable Care Act and the Commonwealth of Massachusetts).
Prior Authorization - A process whereby an insurance carrier or Pharmacy Benefit Manager (PBM) reviews the prescription or treatment plan for a patient with the prescribing physician, to determine whether the treatment is medically necessary and appropriate.
R
Retired Municipal Teacher (RMT) - A retired teacher from a city, town or school district who is receiving a pension from the Teacher's Retirement Board and whose municipality has elected to participate in the GIC RMT program. Retired teachers who participate in the municipal program for GIC health-only benefits are not RMTs.
U
Utilization Review - A health plan's process of reviewing the appropriateness and quality of care provided to patients. It may be done before, at the same time, or after the services are rendered.