HIGH DEDUCTIBLE HEALTH PLAN (HDHP): A health insurance plan for which the enrollee has to pay a
high deductible of at least $1,250 for Self Only coverage or $2,500 for family coverage. The total annual out of pocket costs for the program cannot exceed $6,250 for Self Only plans and $12,500 for family plans. NOTE: These dollar amounts are for 2013 only. Under a HDHP, enrollees have no deductibles for preventive care, but do have higher copays and coinsurance for services outside of the plan’s network. Funds from a HDHP help set up HSAs or HRAs for eligible enrollees.
HEALTH MAINTENANCE ORGANIZATION (HMO): A health plan organized around a network of doctors
and hospitals in a particular geographic or service area, HMOs limit the amount of money that you have to pay out of pocket for your healthcare. They also eliminate the need for filing insurance claims and paperwork. Healthcare services are coordinated between the group of physicians and medical centers and your eligibility for an HMO is determined by where you live or work. Healthcare received from providers outside of your HMO will not be covered unless it is an emergency or your HMO has a reciprocity agreement with HMOs in other service areas.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA): Also known as Personal Care Accounts, HRAs are
commonly associated with CDHPs. They also exist under HDHPs for enrollees that are ineligible for HSAs. A participant may use funds from a HRA, credited to an individual by the insurance company, to pay medical expenses, similar to a HSA. However, unlike a HSA, the money in a HRA does not accrue interest and cannot be transferred if the enrollee changes health plans. HRAs also differ in that a participant may not make deposits into a HRA and insurance companies may impose a limit on the amount that can be deposited.
HEALTH SAVINGS ACCOUNT (HSA): An option for those enrolled in a HDHP program, a HSA allows par-
ticipants to deposit and withdraw funds on a pretax basis for medical expenses. Funds in a HSA accrue interest and are transferrable. There is also no limit to the amount of money that can be deposited in a HSA. To have a HSA, you cannot be someone’s dependent or eligible for Medicare or a healthcare plan other than HDHP. There are a number of regulations associated with a HSA. These are available on the Treasury Department’s HSA page.
MINIMUM RETIREMENT AGE (MRA) +10: A provision that enables you to retire with benefits if you have
ten years of service and are at least at the minimum age of retirement (at least 55). It is important to know that your annuity will be reduced for every month that you are under the age of 62. This equals an annual reduction of about five percent. To avoid this loss, you can postpone your annuity payments, applying for them again two months before you wish for your benefits to be reinstated.
OPEN SEASON: Determined by the Office of Personnel Management, Open Season is a period during which federal
employees can enroll or make changes to their enrollment in federal healthcare plans. Open Season normally lasts from the Monday of the 2nd full work week in November to the Monday of the 2nd full work week in December.
POINT OF SERVICE (POS) PRODUCT: Applying only to an HMO, the POS product allows you to use medical
providers outside of your HMO network. If you choose to use this service, you will have to pay higher deductibles and coinsurance charges for going outside of your HMO network. You will also have to file a claim for reimbursement with your insurance company.
PREFERRED PROVIDER ORGANIZATION (PPO): Part of a network of doctors and hospitals, a Preferred
Provider Organization, saves participants money in that PPO medical providers will charge less for their services if the participant is part of a health plan with PPO partners.
PREMIUM: The rate or amount that you pay for a particular insurance plan, a premium, can be charged biweekly, semimonthly, every 28 days, or monthly.
PRIMARY CARE PHYSICIAN (PCP): The physician or practice that provides your general medical care. Most
plans, especially HMOs, will ask you to designate a PCP. In a HMO, you will have to get a referral or authorization to see another doctor to ensure that you receive the appropriate care for your condition or concern.
QUALIFYING LIFE EVENT (QLE): An event that allows an enrollee in a federal health plan to make changes to their enrollment outside of Open Season.
For additional glossary resources please see:
´ ´ BENEFEDS’ Glossary ´ ´ OPM’s Glossary ´ ´ OPM’s Health Care Plans Reference
43.
Guide to Open Season in Federal Government