You pay for certain benefits with after-tax dollars that come out of your pay after all applicable taxes have been determined and withheld.
The person or persons you designate to receive payment of your life insurance and retirement savings plan. You can name anyone as your beneficiary, and you can change your choice at any time (unless you elect to assign ownership of your insurance to someone else). If you do not have a designated beneficiary at the time of your death, or if your beneficiary dies before you, your insurance will usually be paid in a lump sum to the survivors listed below in the following order of priority (see your plan documents for details):
This is the portion of covered health care costs for which you are financially responsible. For example, if the plan pays 80% of the cost of a service, you would pay the remaining 20% as coinsurance.
The out-of-pocket amount you must pay each plan year before the plan pays for eligible benefits.
You may enroll these eligible dependents:
Your lawful spouse of the opposite gender (does not include parties of a civil union)
Children through the end of the month they turn age 26
A serious medical condition or symptom resulting from injury or illness that arises suddenly and requires immediate care and treatment to avoid endangering life or health.
Evidence of Insurability
Evidence of Insurability (EOI)
This is sometimes called “proof of good health” and is used to qualify for certain amounts of life insurance coverage. You will need to complete an EOI form if you choose to enroll in or increase life insurance coverage outside of your initial eligibility period.
A formulary is a list of medications covered by your prescription plan. If you use a medication that is not on your plan’s formulary, you may be required to pay the full cost. To view the formulary for your plan, visit the plan’s website.
A generic drug is one that is no longer produced only under a brand name. Once a drug’s patent expires, many companies can begin to manufacture “generic” versions of a previously brand-name-only drug. Generic drugs are identical to brand-name drugs in chemical makeup (“active ingredients”), usage, strength and dosage. They are regulated and approved by the FDA, just like brand-name drugs. The price you pay for generic drugs is less than you would pay for brand-name or formulary drugs.
The amount of life insurance available to employees without the need to provide Evidence of Insurability (EOI, or proof of good health).
A provider who has contracted with a health care plan (a medical, dental or vision plan) and has agreed to certain rates. In most cases, you pay less and receive a higher benefit when you use in-network providers. Check with your plan for coverage details.
The costs for health care services negotiated between the insurance carrier and in-network health care providers. Negotiated rates are usually less than usual, customary and reasonable (UCR) charges.
A provider who has not contracted with a health care plan (medical, dental or vision plan) and has not agreed to certain rates. In most cases, you pay more and receive a lower level of benefits when you use out-of-network providers. See your plan for coverage details.
The maximum amount you could pay in any plan year. Eligible expenses above this amount are typically paid by the plan.
The Navigators’ plan year is January 1 through December 31. You cannot change coverage to most benefits during this period, unless you experience a qualifying life event.
Preferred brand-name drugs
Preferred brand-name drugs
A preferred brand-name drug may have a lower cost than a non-preferred drug because it has been identified by the plan as more cost effective. You can find out how different drugs are classified by your plan by visiting the plan’s website.
You pay for these benefits with pre-tax dollars that come out of your pay before federal income and Social Security taxes are withheld—and, in most states, before state and local taxes are withheld. This gives your contributions a special tax advantage and lowers your taxable income, thereby lowering the actual cost to you.
Qualifying life event
Qualifying life event
Qualifying life events include:
Change in legal marital status, such as marriage, divorce or death of your spouse
Change in the number of dependent children due to birth, adoption or death
Change in employment status for you, your spouse or dependent children
Change in dependent eligibility under your current coverage
Significant change in health coverage due to your spouse’s gain or loss of employment
You may make changes to your coverage when you have a qualifying life event; however, you must do so within 31 days of the event.
Specialty drugs require special handling, administration, and/or monitoring. They are typically used to treat complex or chronic conditions. Visit your plan’s website for more information on specialty drug classifications.