Retiree Health Plan Glossary

Centers for Medicare & Medicaid Services (CMS)

The government agency that administers Medicare Parts A and B; CMS contracts with private health plans to administer Parts C and D, as well as with Medicare-Advantage Plans (HMOs) to provide comprehensive medical benefits.

Centers for Medicare & Medicaid Services (CMS)

The government agency that administers Medicare Parts A and B; CMS contracts with private health plans to administer Parts C and D, as well as with Medicare-Advantage Plans (HMOs) to provide comprehensive medical benefits.

Coinsurance

After you meet the deductible, your health plan pays a specified percentage of the charges for covered services. You pay the remaining charges, called coinsurance.

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" shall include:

  • your spouse (including a spouse of a common law marriage) or same-sex domestic partner
  • your or your spouse’s dependent child up to age 26.

Here are additional details:

  • 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 no longer 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.

Note that special rules may apply to dependent children. Please see the Retiree Health SPD 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

A 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 

This benefit covers hospital insurance (i.e., inpatient hospital care, skilled nursing facility care, home health services and hospice care).

Medicare Part B

This benefit covers medical services (i.e., doctor/specialist/x-ray services).

Medicare Part D

A federal program to subsidize the cost of prescription drugs for Medicare beneficiaries.

Part-time Employee

A faculty or staff member working between 17½ and 28 hours per week.

Questions?

Call Human Resources at
215-898-3539