glossary of terms bg

Glossary of Terms


Active full-time employee
Person that works a normal workweek for an employer at a minimum number of required hours.

Canadian Bound Expat (Inpat)
A citizen of a foreign country working in Canada. 

Requires payment of a percentage of the cost of the medical services. Most plans require either a coinsurance or copay: usually not both.

Copayment  (copay)
A flat fee charged each time you visit the doctor or use certain medical services regardless of the cost of the procedure. Doctor visits and pharmaceutical purchases are often subject to copays.

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Money paid out-of-pocket each year before medical plan coverage begins.  Each family member usually has a separate deductible to meet.

A person who is covered by another person’s plan.  It can be a child, spouse or domestic partner.

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A serious illness or condition that comes on suddenly and needs immediate medical care.

Expatriate (Expat)
Any employee working or residing outside of their home country. E.g. An American working in Italy.

Explanation of Benefits (EOB)
A detailed document provided by an insurance carrier outlining the charges, payments and balances of processed claims.

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Health Savings Account (HSA)
An account that can be used to pay for covered health care costs or can be saved for future health care costs.  Plan members must be covered by a high deductible health plan to qualify for an HSA.

High-Deductible Health Plan (HDHP)
A plan that meets Federal regulations and has a higher deductible than standard health plans allowing participants to utilize a health savings account (HSA).

Key Local National (KLN)
An executive, partner or high-level manager working in his/her own country for a foreign company.

Local Nationals (LN)
Citizen of his/her own country working for a foreign company.

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Mail Order Pharmacy
Service available through Aetna Rx Home Delivery® that allows members to save time and money with a three-month supply of certain prescriptions delivered directly to their home.

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A group of health care providers including doctors and hospitals that are contracted with the carrier.  For Aetna health plans, choose the Open Choice PPO Network.

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Out-of-pocket maximum mandate
All cost sharing must apply toward the out-of-pocket maximum including in-network medical, behavioral health and pharmacy cost sharing. Does not include premiums, balance billing amount of non-network providers or spending for non-covered services. The out-of-pocket maximum must include copays, deductibles, and coinsurance.

Over-the-counter drugs (OTC)
Drugs that can be purchased without a prescription and are not covered under the Rx benefits of the plan.

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Approval required for certain care, admission or procedures that must be completed prior to event taking place.  Precertification can also be called:
  • Preauthorization
  • Authorization
  • Certification
  • Prior Authorization

The amount you pay for your insurance policy. Premiums are often deducted from your paycheck.

Preventive or Preventative Care
Services that can help prevent certain diseases and illnesses.  Generally includes annual exams, immunizations and testing for certain diseases.

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Qualifying Event
An event that allows a member to change his or her health benefits.  Some examples include death, job loss, divorce, marriage and the birth of a child.

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A designated time of year when the policy continues but with updated terms such as new rates.

The common symbol describing prescription or pharmacy.

Short Term Traveler or World Traveler
An employee traveling outside of home country for 6 months or less.

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A provider that is trained in a specific medical area such as a dermatologist or cardiologist.Step TherapyA provision requiring members to try certain drugs prior to a particular brand name drug being paid for under the plan.

Step Therapy
A provision requiring members to try certain drugs prior to a particular brand name drug being paid for under the plan.

Third Country National (TCN)
A foreign citizen of working in a country that is not his/her place of residence for a company that is headquartered in another foreign country. E.g. A French citizen working in Brazil for a company headquartered in Japan.

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Urgent Care
Care provided for sudden illness or injury that is not life threatening but requires care to be sought quickly so the person does not develop a more serious problem.

U.S. Bound Expat (Inpat)
A citizen of a foreign country working in the U.S.

U.S. Employee working for a non-US based Company
A U.S. citizen working for a foreign-owned company.

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