The employer benefits industry is incredibly complex and riddled with industry-specific terms and language. Understanding and properly using these terms can make all the difference in communicating effectively and clearly. To help break down the jargon you may see daily, we've compiled a list of some of the most common employer benefits industry terms and acronyms.
---
ADA: Americans with Disability Act. The Americans with Disabilities Act of 1990 or ADA is a civil rights law that prohibits discrimination based on disability.
ADEA: Age Discrimination in Employment Act. The Age Discrimination in Employment Act of 1967 is a United States labor law that forbids employment discrimination against anyone at least 40 years of age in the United States.
ADL: Activities of daily living. This term refers to personal care activities such as bathing, eating, and dressing.
AMS: Agency management system. An AMS is a technology insurance agencies use to organize their book of business and run their operations.
ASO: Administrative services only. ASO is an agreement that companies use when they fund their employee benefit plan but hire a vendor to administer it.
BOR: Broker of record. May also be referred to as AOR (agent of record).
BPS: Benefits placement system. BPS is a new category of enterprise software for brokers and carriers. A BPS enables brokers and carriers to manage the entire placement process in one shared system. Learn more about the core features of a benefits placement system.
BUCA: BlueCross BlueShield, United, Cigna, Aetna. The four largest commercial health insurance companies used by most US employers to provide health insurance for their employees. Note: Since CVS purchased Aetna, it is referred to as CVS/Aetna or CVS Health.
COC: Certificate of coverage. Also referred to as a ‘cert,’' this document breaks out all the policy provisions. COC may also refer to continuity of coverage which specifies that there are no gaps in coverage.
DTQ: Decline to quote. A DTQ is when an insurance carrier declines to provide a quote for a proposal that doesn’t fit their requirements or offerings.
EAP: Employee assistance program. An EAP is an employee benefit program that assists employees with personal or work-related problems that may impact their job performance, health, and mental and emotional well-being.
EE: Employee.
EOB: Explanation of benefits. An EOB is a statement that breakdowns the costs the benefits plan will cover for care or products received and what the member will pay for.
EOI: Evidence of insurability. Also referred to as EVI. EOI is a record of a person's past and current health events. Insurance companies use it to verify whether a person meets the definition of good health.
ER: Employer.
FMLA: Family and Medical Leave Act. The FMLA entitles eligible employees who work for covered employers to take unpaid, job-protected leave in a defined 12-month period for specified family and medical reasons.
FSA: Flexible spending account. An FSA is a pre-tax benefit account used to pay for eligible medical, dental, and vision care expenses not covered by a health care plan.
GA: General agent. A GA is an intermediary between a broker and an insurer, helping manage relationships and provide marketing and sales support.
GI: Guarantee issue. GI is health insurance coverage guaranteed to be issued to applicants regardless of their health status, age, or income.
NPC: No prior coverage. When an employer group purchases an insurance product for the first time, we refer to those products as NPCs. Another frequently used term to describe the employer group is FTB or first-time buyer.
OE: Open enrollment, also called annual enrollment (AE). OE is the time of year that employees can enroll in benefit plans for the upcoming year.
PBM: Pharmacy benefit management. PBMs are third-parties that manage prescription drug benefits on behalf of health insurers and payers.
PEO: Professional employer organization. A PEO performs various employee administration tasks, such as payroll and benefits administration, on behalf of a business.
RFI: Request for information. An RFI requests information from brokers or agents to help create insurance plan proposals.
RFP: Request for proposal. RFPs are documents used to secure proposals for insurance or risk management services. Read our tips on getting better proposals from carriers.
RG: Rate guarantee. An RG is a length of time the insurance company guarantees there won't be any increase to the final premiums during the underwriting process.
SIC: Standard industrial classification. SIC codes are government-issued four-digit numerical codes that categorize the industries that companies belong to based on their business activities.
SLA: Service level agreement (sometimes referred to as Service Guarantee). SLAs define the expectations between a service provider and customer, describing expected services, responsiveness, and performance measurement.
SOB: Summary of benefits. An SOB provides coverage information in a simplified format.
SBC: Summary of benefits and coverage. An SBC is a high-level overview of a health plan's covered benefits and member cost-sharing.
SPD: Summary plan description. An SPD is a detailed document that tells members what the plan covers and how it operates.
SSNRA: Social Security Normal Retirement Age. SSNRA is the normal retirement age under the Federal Social Security Act. It can also be referred to as SSFRA (Social Security Full Retirement Age.)
TIN: Taxpayer identification number. A TIN is an identification number used by the Internal Revenue Service (IRS) in the administration of tax laws. It is sometimes referred to as SSN for individuals or EIN for business entities.
TPA: Third-party administrator. A third-party administrator provides operational services such as claims processing and employee benefits management under contract to another company.
UCR: Usual and customary. UCR fees are out-of-pocket fees that a health insurance policyholder must pay for services. UCR fees are based on the services provided to policyholders and the area of the country where the services are being provided.
UW: Underwriting. Underwriting is the process an insurer takes in deciding whether to issue a policy for a customer and what conditions and pricing will be applied to the policy based on medical and lifestyle information provided by the applicant. Read about underwriting consulting at ThreeFlow.
Acronyms to describe products
The following acronyms are used to describe specific insurance products. You'll typically find them in plan documents and proposals.
ACC: Accident coverage. May also be referred to as AI (accident insurance). Read our breakdown on worksite insurance.
AD&D: Accidental death and dismemberment
BL: Basic life.
CI: Critical illness coverage. Read our breakdown on worksite insurance.
FI: Fully insured.
HI: Hospital indemnity coverage. Read our breakdown on worksite insurance.
LTD: Long-term disability. Read our benefits breakdown on long-term disability.
SI: Self-insured, also referred to as self-funded.
SL: Stop loss. Read our breakdown on stop loss insurance.
STD: Short-term disability. Read our breakdown on short-term disability. ATP STD: Advice to pay short-term disability, including medical management of claims and check cutting.
VI: Vision insurance.
----
Interested in more industry insights? Subscribe to ThreeFlow's blog for weekly updates direct to your inbox.
%20(1).jpg)
