GLOSSARY

1 | Postal Service Health Benefits (PSHB) Program | The Postal Service Health Benefits (PSHB) Program is a specialized health benefits program for employees of the United States Postal Service (USPS). It provides comprehensive health insurance coverage to USPS employees and retirees, including medical, dental, and vision benefits. The program is designed to ensure that USPS employees have access to affordable healthcare options throughout their careers and into retirement.

2 | Medicare | Medicare is a federal health insurance program primarily for people aged 65 and older, as well as some younger individuals with disabilities or specific health conditions. It consists of different parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). Medicare helps cover various healthcare services, but it may not cover all costs, leading some individuals to seek supplemental insurance.

3 | USPS Health Benefits | USPS Health Benefits refer to the healthcare coverage options available to employees of the United States Postal Service (USPS). These benefits typically include medical, dental, vision, and prescription drug coverage. USPS offers a range of health plans to its employees, allowing them to choose the coverage that best fits their needs and preferences.

4 | Federal Employees Health Benefits (FEHB) Program | The Federal Employees Health Benefits (FEHB) Program is a system that provides healthcare coverage to federal employees, retirees, and their dependents, including USPS employees. It offers a variety of health insurance plans from different providers, allowing participants to select the coverage that meets their individual needs. The FEHB Program is administered by the U.S. Office of Personnel Management (OPM).

5 | Open Season | Open Season is a designated period each year during which federal employees, including USPS employees, can enroll in or make changes to their health insurance coverage under the Federal Employees Health Benefits (FEHB) Program. During Open Season, employees can switch plans, add or remove dependents, or make other adjustments to their coverage. It typically occurs in the fall and allows employees to review their options and select the most suitable health plan for the upcoming year.

6 | Health Maintenance Organization (HMO) | A Health Maintenance Organization (HMO) is a type of health insurance plan that typically requires members to choose a primary care physician (PCP) and obtain referrals from the PCP to see specialists. HMOs generally have a network of healthcare providers, and coverage is usually limited to services received within the network. This structure often emphasizes preventive care and may require members to pay copayments or coinsurance for covered services.

7 | Preferred Provider Organization (PPO) | A Preferred Provider Organization (PPO) is a type of health insurance plan that offers more flexibility in choosing healthcare providers compared to HMOs. PPOs have a network of preferred providers, but members can typically see out-of-network providers at a higher cost. PPOs often do not require referrals to see specialists, and members may have higher out-of-pocket costs for services received outside the network.

8 | High Deductible Health Plan (HDHP) | A High Deductible Health Plan (HDHP) is a type of health insurance plan with lower premiums and higher deductibles compared to traditional plans. HDHPs are often paired with Health Savings Accounts (HSAs), allowing individuals to save money tax-free to pay for qualified medical expenses. While HDHPs can provide cost savings for healthy individuals, they may lead to higher out-of-pocket expenses for those requiring frequent medical care.

9 | Health Savings Account (HSA) | A Health Savings Account (HSA) is a tax-advantaged savings account available to individuals enrolled in High Deductible Health Plans (HDHPs). Contributions to HSAs are tax-deductible, and funds can be used to pay for qualified medical expenses, including deductibles, copayments, and coinsurance. HSAs offer the advantage of tax-free growth and withdrawals for medical expenses, making them a valuable tool for managing healthcare costs.

10 | Flexible Spending Account (FSA) | A Flexible Spending Account (FSA) is an employer-sponsored benefit that allows employees to set aside pre-tax dollars to pay for qualified medical expenses. FSAs can be used to cover expenses such as copayments, deductibles, prescription medications, and certain medical supplies. Unlike Health Savings Accounts (HSAs), funds in FSAs must be used by the end of the plan year or forfeited, although some plans offer a grace period or carryover option.

11 | Premium | In the context of health insurance, a premium is the amount of money an individual or employer pays to an insurance company to maintain coverage. Premiums are typically paid on a monthly basis and may vary depending on factors such as the type of plan, coverage level, age, and location. Employers often contribute to premiums for employee health insurance as part of their benefits package.

12 | Copayment | A copayment, or copay, is a fixed amount that an insured individual pays for covered healthcare services at the time of service. Copayments are usually set amounts for specific services, such as doctor visits, prescription medications, or specialist consultations. Copayments are separate from deductibles and coinsurance and help share the cost of healthcare between the insurer and the insured.

13 | Coinsurance | Coinsurance is the percentage of the cost of covered healthcare services that an insured individual is required to pay after meeting their deductible. Unlike copayments, which are fixed amounts, coinsurance represents a percentage of the total cost of services. For example, if an insurance plan has a coinsurance rate of 20%, the insured individual would pay 20% of the allowed amount for covered services, while the insurance company pays the remaining 80%.

14 | Deductible | A deductible is the amount of money that an insured individual must pay out of pocket for covered healthcare services before their insurance plan begins to pay. Deductibles vary among insurance plans and may apply to specific services or to all covered expenses within a certain time period, such as a calendar year. Once the deductible is met, the insurance plan typically begins to cover a portion of the remaining costs through coinsurance or copayments.

15 | Out-of-Pocket Maximum | An out-of-pocket maximum is the most an insured individual is required to pay for covered healthcare services during a specified period, such as a calendar year. Once the out-of-pocket maximum is reached, the insurance plan typically covers 100% of additional covered expenses for the remainder of the period. Out-of-pocket maximums include deductibles, copayments, and coinsurance but do not usually include premiums or expenses for services not covered by the plan.

16 | Prescription Drug Coverage | Prescription drug coverage is a component of health insurance plans that helps pay for the cost of prescription medications. It may be included as part of a comprehensive health insurance plan or offered as a standalone benefit. Prescription drug coverage varies among plans and may involve copayments, coinsurance, or coverage through a formulary—a list of preferred medications covered by the plan.

17 | Vision Coverage | Vision coverage is a type of health insurance benefit that helps cover the cost of eye care services, such as routine eye exams, prescription eyeglasses, and contact lenses. Vision coverage may be included as part of a comprehensive health insurance plan or offered as a standalone benefit. Some plans may also provide coverage for corrective procedures like LASIK surgery, although coverage limitations and eligibility criteria may apply.

18 | Dental Coverage | Dental coverage is a type of health insurance benefit that helps cover the cost of dental care services, including preventive care, such as routine cleanings and exams, as well as restorative procedures like fillings and crowns. Dental coverage may be included as part of a comprehensive health insurance plan or offered as a standalone benefit. Coverage may vary in terms of covered services, network providers, and out-of-pocket costs.

19 | Network Provider | A network provider is a healthcare professional, facility, or service that has an agreement with an insurance company to provide services to insured individuals at negotiated rates. Insurance plans often have networks of preferred providers, and using in-network providers typically results in lower out-of-pocket costs for covered services. Out-of-network providers may still be covered by insurance plans, but at higher costs to the insured individual.

20 | Explanation of Benefits (EOB) | An Explanation of Benefits (EOB) is a statement that insurance companies send to insured individuals detailing the healthcare services rendered, the amount billed by providers, the amount covered by the insurance plan, and any remaining balance owed by the insured individual. EOBs serve as a summary of healthcare expenses and help insured individuals understand how their insurance benefits are being utilized. It is important for insured individuals to review EOBs carefully to ensure accuracy and to reconcile any discrepancies with their providers or insurance companies.

21 | Dependent Coverage | Dependent coverage refers to the inclusion of family members, such as spouses, children, or domestic partners, under an individual’s health insurance plan. Many health insurance plans allow policyholders to enroll their dependents for coverage, often at an additional cost. Dependent coverage ensures that family members have access to necessary healthcare services and may include medical, dental, vision, and prescription drug coverage.

22 | Pre-existing Condition | A pre-existing condition is a health condition or illness that an individual has before enrolling in a new health insurance plan. Before the Affordable Care Act (ACA), insurers could deny coverage or charge higher premiums based on pre-existing conditions. However, the ACA prohibits such practices, ensuring that individuals cannot be denied coverage or charged more due to pre-existing conditions. This provision provides important protections for individuals with chronic or ongoing health issues.

23 | Health Maintenance Organization Act of 1973 | The Health Maintenance Organization Act of 1973 (HMO Act) is a federal law that encouraged the establishment of Health Maintenance Organizations (HMOs) as a form of managed care. The HMO Act provided federal grants and loans to support the development of HMOs, which prioritize preventive care and emphasize cost-effective healthcare delivery. This legislation played a significant role in shaping the landscape of healthcare delivery and insurance in the United States.

24 | Consolidated Omnibus Budget Reconciliation Act (COBRA) | The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a federal law that allows eligible individuals to continue their group health insurance coverage for a limited period after experiencing certain qualifying events, such as job loss or reduction in work hours. COBRA coverage is typically more expensive than employer-sponsored coverage since the individual is responsible for the full premium plus a small administrative fee. However, COBRA provides important continuity of coverage during times of transition.

25 | Health Insurance Marketplace | The Health Insurance Marketplace, also known as the Health Insurance Exchange, is an online platform where individuals and families can compare and purchase health insurance plans. Established by the Affordable Care Act (ACA), the Marketplace offers a range of qualified health plans that meet certain standards for coverage and affordability. It also provides information about financial assistance programs, such as premium tax credits and cost-sharing reductions, to help make coverage more affordable for eligible individuals.

26 | Premium Tax Credit | A Premium Tax Credit (PTC) is a refundable tax credit available to eligible individuals and families with low to moderate incomes to help offset the cost of health insurance premiums purchased through the Health Insurance Marketplace. The amount of the premium tax credit is based on household income and the cost of benchmark health insurance plans in the Marketplace. Individuals can choose to have the credit applied directly to their monthly insurance premiums or receive it as a refund when filing their federal income taxes.

27 | Cost-Sharing Reduction | A Cost-Sharing Reduction (CSR) is a subsidy available to eligible individuals and families with low to moderate incomes to help reduce out-of-pocket costs, such as deductibles, copayments, and coinsurance, for healthcare services obtained through the Health Insurance Marketplace. CSR subsidies are available to those who enroll in silver-level health insurance plans through the Marketplace and are based on household income. These subsidies provide additional financial assistance to make healthcare more affordable for eligible individuals.

28 | Essential Health Benefits | Essential Health Benefits (EHBs) are a set of ten categories of healthcare services that health insurance plans must cover under the Affordable Care Act (ACA). These categories include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive and wellness services, and pediatric services, including oral and vision care. EHBs ensure that all Marketplace plans offer comprehensive coverage to enrollees.

29 | Qualified Health Plan (QHP) | A Qualified Health Plan (QHP) is a health insurance plan that meets the standards set forth by the Health Insurance Marketplace established under the Affordable Care Act (ACA). To be considered a QHP, a health insurance plan must cover Essential Health Benefits (EHBs), comply with established limits on cost-sharing, and meet other requirements for coverage and consumer protections. QHPs are available for purchase through the Marketplace and must meet certain standards to be eligible for premium tax credits and other financial assistance.

30 | Catastrophic Health Insurance | Catastrophic health insurance is a type of health insurance plan that offers minimal coverage with low premiums and high deductibles. Catastrophic plans are designed to provide protection against major medical expenses, such as hospitalizations or serious illnesses, while minimizing monthly premium costs. These plans are typically available to individuals under 30 years old or those who qualify for a hardship exemption from the Health Insurance Marketplace.

31 | Medicaid | Medicaid is a joint federal and state program that provides health insurance coverage to low-income individuals and families, including children, pregnant women, elderly adults, and people with disabilities. Eligibility for Medicaid varies by state and is based on income, household size, and other factors. Medicaid covers a broad range of healthcare services, including hospitalizations, physician visits, prescription medications, and long-term care. The program plays a crucial role in providing healthcare coverage to vulnerable populations across the United States.

32 | Medicare Advantage (Part C) | Medicare Advantage, also known as Medicare Part C, is an alternative to traditional Medicare offered by private insurance companies approved by Medicare. Medicare Advantage plans provide all the benefits of Medicare Part A (hospital insurance) and Part B (medical insurance), and often include additional benefits such as prescription drug coverage (Part D), dental, vision, and wellness programs. These plans may have different costs, coverage rules, and provider networks than traditional Medicare.

33 | Medicare Supplement Insurance (Medigap) | Medicare Supplement Insurance, also known as Medigap, is private health insurance designed to supplement Original Medicare (Part A and Part B) by covering some of the out-of-pocket costs that Medicare does not pay, such as deductibles, copayments, and coinsurance. Medigap policies are sold by private insurance companies and are standardized into ten plans labeled A through N, each offering different levels of coverage. Medigap policies help Medicare beneficiaries manage their healthcare expenses more effectively.

34 | Federal Employees Dental and Vision Insurance Program (FEDVIP) | The Federal Employees Dental and Vision Insurance Program (FEDVIP) is a voluntary program that offers dental and vision insurance coverage to federal employees, retirees, and their eligible family members. FEDVIP provides access to a range of dental and vision plans from various private insurance carriers, allowing participants to select coverage that best meets their needs. Enrollment in FEDVIP is separate from enrollment in the Federal Employees Health Benefits (FEHB) Program.

35 | Long-Term Care Insurance | Long-term care insurance is a type of insurance designed to cover the costs associated with long-term care services, such as assistance with activities of daily living (ADLs), nursing home care, and in-home care for chronic illnesses or disabilities. Long-term care insurance policies vary in coverage, benefit limits, and eligibility criteria. These policies help individuals plan for the potential expenses of long-term care and protect against the financial burden it may impose on themselves and their families.

36 | Health Reimbursement Arrangement (HRA) | A Health Reimbursement Arrangement (HRA) is an employer-funded benefit that reimburses employees for eligible medical expenses not covered by their health insurance plan. Employers contribute a specified amount to the HRA, which employees can use to pay for qualified medical expenses, such as deductibles, copayments, and coinsurance. HRAs are funded solely by the employer and can be a valuable tool for offsetting healthcare costs for employees.

37 | Flexible Spending Arrangement (FSA) | A Flexible Spending Arrangement (FSA) is an employer-sponsored benefit that allows employees to set aside pre-tax dollars to pay for eligible medical expenses. FSAs can be used to cover a wide range of healthcare costs, including deductibles, copayments, prescription medications, and certain medical supplies. Funds in an FSA must be used within the plan year or forfeited, although some plans offer a grace period or carryover option.

38 | Health Equity | Health equity refers to the principle that all individuals should have the opportunity to attain their highest level of health regardless of their social or economic circumstances. Achieving health equity involves addressing systemic barriers to healthcare access and ensuring that everyone has access to quality healthcare services, regardless of race, ethnicity, income, or geographic location. Health equity is essential for promoting overall well-being and reducing disparities in health outcomes among different populations.

39 | Utilization Review | Utilization review is a process used by health insurance companies to evaluate the medical necessity and appropriateness of healthcare services and treatments. It involves reviewing the utilization of healthcare resources to ensure that services are delivered efficiently and effectively. Utilization review may include pre-authorization requirements, concurrent review of ongoing treatments, and retrospective review of services already provided to determine their medical necessity and appropriateness.

40 | Grievance Procedure | A grievance procedure is a formal process for resolving disputes or complaints between individuals and their health insurance plans. It provides a mechanism for individuals to voice concerns about coverage decisions, claim denials, provider issues, or other problems they encounter with their health insurance coverage. Grievance procedures typically involve submitting a written complaint to the insurance company, which then investigates the issue and provides a response within a specified timeframe.

41 | Preventive Care | Preventive care refers to healthcare services and screenings aimed at preventing or detecting health problems before they become more serious or require costly treatments. Examples of preventive care include routine vaccinations, cancer screenings, cholesterol screenings, blood pressure checks, and counseling on healthy lifestyle behaviors. Preventive care is an essential component of healthcare that helps individuals stay healthy, detect diseases early, and reduce the overall burden of illness.

42 | Telemedicine | Telemedicine, also known as telehealth, is the remote delivery of healthcare services using telecommunications technology, such as video conferencing, telephone consultations, or secure messaging platforms. Telemedicine allows patients to access medical care from a distance, overcoming barriers related to geographic location, transportation, or mobility. It is particularly useful for follow-up appointments, routine consultations, mental health services, and managing chronic conditions.

43 | Explanation of Coverage (EOC) | An Explanation of Coverage (EOC) is a document provided by health insurance companies to policyholders that outlines the terms and conditions of their insurance coverage. The EOC typically includes information about covered benefits, exclusions, limitations, cost-sharing requirements, and procedures for filing claims. Policyholders should review their EOC carefully to understand their rights and responsibilities under their health insurance plan.

44 | Health Savings Account (HSA) Eligible Expenses | Health Savings Account (HSA) eligible expenses are healthcare costs that qualify for reimbursement using funds from an HSA. Eligible expenses include a wide range of medical, dental, and vision services, such as doctor visits, prescription medications, dental cleanings, eyeglasses, and contact lenses. HSA funds can also be used to pay for certain over-the-counter medications, medical supplies, and equipment, as well as eligible expenses for dependents covered under the HSA.

45 | Formulary | A formulary is a list of prescription medications covered by a health insurance plan and approved for use by the plan’s pharmacy benefit manager. Formularies categorize medications into tiers based on their cost and clinical effectiveness, with lower-tier medications typically having lower copayments or coinsurance. Health insurance plans may have different formularies, and medications not included on the formulary may require prior authorization or may not be covered at all.

46 | Long-Term Disability Insurance | Long-term disability insurance is a type of insurance that provides income replacement benefits to individuals who are unable to work due to a long-term illness, injury, or disability. Long-term disability insurance typically replaces a percentage of the insured individual’s income for an extended period, such as several years or until retirement age, depending on the terms of the policy. It helps protect against the financial impact of a disabling condition by providing ongoing income support.

47 | Short-Term Disability Insurance | Short-term disability insurance is a type of insurance that provides income replacement benefits to individuals who are temporarily unable to work due to a short-term illness, injury, or disability. Short-term disability insurance typically covers a portion of the insured individual’s income for a limited duration, such as a few weeks to several months, depending on the terms of the policy. It helps bridge the gap between employment income and the onset of long-term disability benefits, if necessary.

48 | Health Literacy | Health literacy refers to an individual’s ability to obtain, understand, and act on health information and services to make informed decisions about their healthcare. It encompasses skills such as reading comprehension, numeracy, critical thinking, and communication, as well as cultural and social factors that influence health behaviors. Improving health literacy is essential for empowering individuals to navigate the healthcare system, advocate for their health needs, and make informed choices about their well-being.

49 | Premium Assistance | Premium assistance, also known as premium subsidies or premium tax credits, is financial assistance provided to eligible individuals and families to help reduce the cost of health insurance premiums. Premium assistance is available to individuals with low to moderate incomes who enroll in health insurance plans through the Health Insurance Marketplace. The amount of premium assistance is based on household income and is designed to make health insurance more affordable for those who qualify.

50 | Guaranteed Issue | Guaranteed issue is a provision that requires health insurance companies to offer coverage to all individuals, regardless of their health status or pre-existing conditions. Under guaranteed issue rules, insurers cannot deny coverage, impose exclusions, or charge higher premiums based on an individual’s health history. This provision ensures access to health insurance for individuals with pre-existing conditions and prevents discrimination in the insurance market based on health status.