Benefits Glossary

Federal law requiring most Americans to have health insurance and establishing minimum standards for health plans.

Stop loss insurance that protects against total claims exceeding a predetermined amount across all covered members during the plan year.

The dollar amount at which stop loss coverage begins to pay. Also called the deductible level.

A reference point for comparison. Bnchmrk reports include Low (25th percentile), Median (50th percentile), and High (75th percentile) benchmarks.

Insurance company that underwrites and provides health insurance coverage to employers and individuals.

Period after a plan ends during which claims incurred during the coverage period can still be submitted for payment.

Federal law allowing employees to continue health coverage after job loss, divorce, or other qualifying events, typically for 18-36 months.

A filtered dataset of employers meeting user-specified criteria (industry, location, headcount) from Bnchmrk's Total Employer Dataset.

The percentage of covered medical expenses you pay after meeting your deductible. Shown as a percentage (like 20%).

A single premium rate that applies regardless of age, gender, or other demographic factors. Often used in stop loss pricing.

The 12-month period during which stop loss coverage is effective, often different from the health plan year.

Fixed dollar amount you pay for specific services like doctor visits or prescriptions, typically paid at time of service.

A single measurement in a dataset, such as a deductible amount, premium rate, or percentage of employers offering a benefit.

Bnchmrk's multi-stage process ensuring employer and plan records meet quality standards before inclusion in benchmarking datasets.

The amount you must pay out-of-pocket for covered services before insurance begins paying. Can be individual or family amounts.

Eligible family members who can be covered under an employee's health plan, typically spouse and children under 26.

Visual representation showing how plan values spread across percentiles, helping identify where your plan falls relative to benchmarks.

The date when insurance coverage begins or changes take effect.

A plan design where individual deductibles apply within family coverage, allowing one member to meet their own deductible before the full family deductible is met.

Health plan that provides coverage only for services from in-network providers, except in emergency situations.

Employee Retirement Income Security Act. Federal law setting standards for employer-sponsored benefit plans and fiduciary responsibilities.

Health insurance that covers the employee plus eligible dependents, typically spouse and children.

List of prescription drugs covered by a health plan, typically organized into cost-sharing tiers.

A health plan with higher deductibles and lower premiums, often paired with HSAs.

Employer-funded account that reimburses employees for qualified medical expenses and individual health insurance premiums.

Tax-advantaged account available with qualifying high-deductible health plans, allowing triple tax savings for medical expenses.

Healthcare providers and facilities that have contracted with your insurance plan to provide services at negotiated rates.

Health insurance that covers only the employee, not dependents.

An exclusion in stop loss coverage for a specific individual with known high-cost medical conditions.

A hybrid funding arrangement combining features of fully insured and self-funded plans, where employers pay a fixed monthly amount that covers claims, stop loss insurance, and administrative fees.

The middle value in a dataset, representing the 50th percentile benchmark in Bnchmrk reports.

Type of health insurance that meets ACA requirements, avoiding tax penalties for individuals.

Bnchmrk's method for collecting real-time plan data from benefit consultants and employers nationwide.

Annual period when employees can enroll in or make changes to their benefit elections.

Healthcare providers that haven't contracted with your insurance plan, typically resulting in higher out-of-pocket costs.

The most you'll pay for covered services in a plan year. After reaching this limit, insurance pays 100% of covered costs.

Shows where your plan falls within your cohort's value distribution. Higher percentiles indicate more competitive (employee-favorable) benefits.

The 12-month period during which health plan coverage is active, often different from calendar year.

Health plan offering flexibility to see any provider, with lower costs for in-network care and partial coverage out-of-network.

The cost for insurance coverage, typically shown as monthly or annual amounts. Can be for individuals, families, or specific coverage types.

Requirement to get approval from your health plan before receiving certain services or medications.

Life change that allows employees to modify benefit elections outside of open enrollment.

Statistical division of data into four equal parts, with 25th and 75th percentiles representing low and high benchmarks.

Number of data points or plans included in a benchmarking analysis, affecting statistical reliability.

Health plan where the employer pays claims directly rather than paying premiums to an insurance company. Often paired with stop loss insurance.

Stop loss insurance that protects against high claims from any individual covered member exceeding a predetermined amount.

The dollar amount of claims per individual that must be paid before specific stop loss coverage begins.

Insurance that protects self-funded employers against catastrophically high medical claims, available as specific and/or aggregate coverage.

Document required by ERISA that explains employee benefit plan features in plain English.

Company that handles administrative services like claims processing for self-funded employers.

The complete set of validated employers with current plans and rates in Bnchmrk's database. Users filter this to create customized cohorts.