Glossary

Second Opinion

Visiting another physician or surgeon for an opinion regarding a diagnosis, course of treatment or specific types of elective surgery. Second opinions are generally voluntary, but may be required in certain instances under some health plans.

Section 213(d)

Section 213(d) of the Internal Revenue Code outlines what a "qualified medical expense" is for purposes of FSA, HRA, HSA and MSA spending. Expenditures from an FSA or HRA must be a qualified medical expense under this code section. HSA funds may be withdrawn for other purposes, but such withdrawals are taxable and may be subject to an additional tax penalty.

Self-Insured

Also called "self-funded." An employer who takes on the financial responsibility for paying the health benefits claims of its employees is said to be "self-insured" (versus a "fully insured" employer, who pays a health insurance company to take on financial responsibility for claims). Self-insured plans can be administered by the employer or an outside company.

Service Area

The geographic area in which a health plan is licensed to operate (where applicable) or, when licensing is not required, the geographic area where an adequate network is established to provide services covered under a benefits plan.

Social Security Retirement Benefits

A government supported retirement benefit program funded through a federal income tax and paid to Americans based on age, number of years worked and income earned over an individual's career. Higher lifetime earnings result in higher benefits, while time off and lower income years may result in lower benefit payments. Age 62 is the earliest possible retirement age for Social Security benefits, and full retirement age is determined by year of birth. Choosing to collect retirement benefits before you reach full retirement age results in permanently reduced benefits.

Specialist

A physician who provides medical care in a medical or surgical specialty or subspecialty (for example, dermatologist, oncologist, etc.).

Subscriber

The individual covered under an employer's group agreement or group insurance policy. If an employer makes family coverage available, the subscriber may enroll eligible dependents in the benefits plan.