Term
| Tripod of Economic Security |
|
Definition
| government provided; employer provided; individual provided |
|
|
Term
| Broad View of Employee Benefits (EB) |
|
Definition
| legally required; pay for time not worked; employer share; discounts; severance; education; childcare |
|
|
Term
|
Definition
| Attract; Retain; Increase Productivity and Morale; Social Objectives |
|
|
Term
| Labor Management and Relations Act |
|
Definition
| aka Taft-Hartley Act; labor unions bargain in good faith to include fringe benefits; established distinction between retirement and welfare benefits |
|
|
Term
| National Labor Relations Board |
|
Definition
|
|
Term
|
Definition
| ER contributions usually deductible; ER contributions not usually considered income for EEs; some accumulate tax-free for EEs |
|
|
Term
| Starting Point for EB Plan Design |
|
Definition
| Setting overall objectives |
|
|
Term
| Functional Approach to EB planning |
|
Definition
| Analyze program as a whole re: ability to meet EE needs and manage loss; can eliminate overlap and gaps; keeps plan current, competitive, in compliance |
|
|
Term
| 3 Types of Total Comp/Benefits ERs may adopt |
|
Definition
| Average; High to attract higher level EEs; Low |
|
|
Term
| Compensation/Service Oriented Philosophy |
|
Definition
| Relate EE benefits to compensation or service; level of benefits tied to salary or pay levels of EEs and YOS |
|
|
Term
| Benefit/Needs Oriented Philosophy |
|
Definition
| Focuses on needs of EEs and dependents |
|
|
Term
|
Definition
| Medical; DI; death; retirement; capital accumulation; unemployment; mental health; property loss; dependent care; education; LTC; investments |
|
|
Term
|
Definition
| some % of estimated final pay whether through retirement (social security, investments, etc.) or DI (income from all sources under Total Comp) |
|
|
Term
| Protection Oriented Benefits |
|
Definition
| Protect EEs and dependents from serious loss exposures; may have short probationary period |
|
|
Term
| Accumulation Oriented Benefits |
|
Definition
| Reward EE for long service; usually have long probationary period |
|
|
Term
|
Definition
| uncertainty with respect to possible loss |
|
|
Term
|
Definition
1. Pure
2. Speculative
3. Property
4. Legal |
|
|
Term
|
Definition
| either it will happen or it won't |
|
|
Term
|
Definition
|
|
Term
|
Definition
| potential losses to value of real or personal property |
|
|
Term
|
Definition
| losses resulting from negligence or wrongful actions |
|
|
Term
|
Definition
| avoid; control; retain; transfer; insure |
|
|
Term
|
Definition
|
|
Term
|
Definition
| A condition that increases probability of a peril occurring |
|
|
Term
|
Definition
1. Physical
2. Morale
3. Moral |
|
|
Term
|
Definition
|
|
Term
|
Definition
| carelessness or indifference |
|
|
Term
|
Definition
| dishonesty or character defect |
|
|
Term
|
Definition
| One is placed basically in the same situation that existed prior to a loss (i.e. reimbursement for damaged property) |
|
|
Term
| Advantages to using insurance to fund EB |
|
Definition
| Known premium; Outside administration; Financial backing; Cost management; Economy |
|
|
Term
| Disadvantages of using insurance to fund EB |
|
Definition
| Possible additional costs; EE satisfaction |
|
|
Term
|
Definition
| Large homogenous risks; verifiable and measurable loss; not catastrophic; chance of loss can be calculated; reasonable premium; accidental and unintentional from insured's standpoint |
|
|
Term
|
Definition
| fee for service; no provider restrictions; providers not under contract and set own pricing; balance billing; often self-funded; experience rated; limited benefits for MH/SA |
|
|
Term
|
Definition
| virtually same as Standard; Basic UM; EE must initiate UM reviews; providers not bound to accept any specific reimbursement |
|
|
Term
|
Definition
| Choice of provider IN and OON; use steerage to encourage IN; IN provider handle claims; EE handles claims OON; IN provider handle UM; benefits paid to providers at established rates; OON balance bill; experience rated |
|
|
Term
|
Definition
| Blends HMO and PPO; established network of providers; steerage to encourage IN; EE must elect PCP; PCP is gatekeeper; large IN and OON differentials; varied reimbursement; experience rated |
|
|
Term
|
Definition
| restricted provider choice; all care must be IN except emergencies; must select PCP every year; provider processes claims; internal UM; community rated; usually an option to EEs |
|
|
Term
| Disability Adjusted Life Years (DALYs) |
|
Definition
| measures lost years of healthy life |
|
|
Term
| Mental Health Parity Act of 1996 |
|
Definition
| prohibits lifetime or annual max on MH unless comparable to medical and surgical limits; applies to ERs with 51+ FT EEs; only applies to groups that include MH in benefits package |
|
|
Term
| Definition of Managed Care |
|
Definition
| Includes those programs intended to influence and direct the delivery of healthcare thru Plan Design; Access to a specified group of providers; UM programs |
|
|
