Retiree Health Plan Glossary

Copay - A flat per-service charge that you pay for services such as doctor visits or prescriptions.

Eligible Dependent - For purposes of the Plan, an "eligible dependent" includes your spouse (including a spouse of a common law marriage) or same-sex domestic partner, and your or your spouse’s dependent child up to age 26.

Please note these additional details for eligibility of dependents:

• Children are eligible for coverage regardless of their student, marital, or IRS dependent status.
• Children do not have to live with you or depend on you for financial support to be eligible.
• Children over age 19 do not have to be full-time college students to remain on coverage.
• Disabled children who are unable to earn a living may be covered beyond age 26, provided the disability began before age 26 and has been certified by your insurance carrier.
• The coverage does not extend to your child’s spouse/partner or children.
• Your same-sex domestic partner’s unmarried child (subject to the same age, student status and disability rules described above) provided the child resides in your household for more than one-half of the year (temporary absences due to special circumstances, including absences due to illness, education, business, vacation or military service are not treated as absences) and receives more than one-half of his/her support and maintenance from your same-sex domestic partner.

Other rules may apply to dependent children. Please see the SPD for the University of Pennsylvania Health and Welfare Plan for Retirees and Disabled Employees for more information.

Full-time Employee - A faculty or staff member working a minimum of 35 hours per week.

Generic Drug - A drug product in place of a brand name drug which: 1) contains the same active ingredients; 2) is identical in dose, form and administrative method; 3) has the same indications, cautions and instructions; and 4) is produced under the same FDA Good Manufacturing Practices.

Medicare - Federal government health insurance program for people age 65 or older, people under age 65 with certain disabilities and people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

• Medicare Part A - Covers hospital insurance (e.g., inpatient hospital care, skilled nursing facility care, home health services and hospice care).
• Medicare Part B - Covers medical services (e.g., doctor/specialist/x-ray services).
• Medicare Part D - Subsidizes the cost of prescription drugs for Medicare beneficiaries.

Part-time Employee - A faculty or staff member working between 17½ and 28 hours per week.

Qualifying Life Event - An event that permits you to make a change to your insurance coverage outside of the annual selection period. Qualifying life events include birth, death, marriage, divorce, relocation out of coverage area, etc. If you have a qualifying life event, you can change your insurance coverage within 30 days of the event.