Benefits Glossary

401(a)

An employer-funded retirement account used to receive AdventHealth's matching contributions. To receive employer contributions, you must contribute to your 403(b) and meet the plan's eligibility requirements.

403(b)

A retirement savings plan that lets you save for retirement through payroll deductions. You can choose pre-tax or Roth contributions, change your contribution amount and may be eligible to receive an AdventHealth company match deposited into your 401(a) account.

457(b)

A retirement savings plan available to eligible team members after they have reached the IRS contribution limit for their 403(b). It allows additional pre-tax or Roth retirement contributions, subject to IRS limits.

Accident insurance

Provides a cash benefit if you experience a covered accidental injury or accident. The benefit can help pay for eligible expenses, such as deductibles, copays or everyday costs during recovery.

Adoption assistance

A benefit that helps reimburse eligible expenses related to the legal adoption of a child, subject to plan eligibility, plan provisions and IRS limits.

Allowed amount

The maximum amount your health plan will pay for a covered healthcare service. Your deductible, copay or coinsurance is based on this amount.

Americans with Disabilities Act (ADA)

A federal law that protects qualified individuals with disabilities from discrimination and may entitle them to reasonable workplace accommodations, when appropriate.

Balance bill

A bill for the difference between what a provider charges and what the plan pays. This can happen with out-of-network care.

Beneficiary

The person you choose to receive benefits like life insurance or retirement savings if you pass away.

Benefit year

The 12-month period during which your benefits are in effect. For AdventHealth, the benefit year runs January 1 through December 31.

Benefits-eligible team member

A team member who meets the eligibility requirements to enroll in AdventHealth benefit plans based on their employment status and scheduled hours.

Coinsurance

Percentage of the cost you pay for covered services after you've met your deductible. For example, if your coinsurance is 20%, your health plan pays the remaining 80%.

Company match

Money AdventHealth contributes to your retirement account based on your eligible 403(b) contributions, subject to plan eligibility and contribution rules.

Continuation of coverage (COC)

Temporary continuation of health coverage available after certain qualifying events, such as losing your job or having your work hours reduced. Because AdventHealth's health plan is a church plan and not subject to COBRA, eligible individuals may be offered Continuation of Coverage (COC) instead, in accordance with plan provisions.

Copay

Set dollar amount you pay when you receive certain healthcare services or fill a prescription.

Covered service or covered expense

Healthcare service or supply your health plan helps pay for under your plan.

Critical illness insurance

Provides a lump-sum cash benefit if you're diagnosed with a covered critical illness, such as a heart attack, stroke or certain types of cancer. The benefit can be used for medical expenses or other everyday costs.

Deductible

The amount you pay for covered healthcare services before your health plan begins paying its share of the cost.

Disability

A physical or mental condition that limits a person's ability to perform one or more major life activities or work. Depending on the condition, a disability may be temporary or long-term.

Eligible dependents

Family members who meet the requirements to enroll in coverage under the AdventHealth benefits program. Eligible dependents include:

• Your legal spouse, or any individual required to be treated as a spouse under applicable state law
• Your children up to age 26, including biological children, adopted children, foster children, stepchildren, or children covered under a Qualified Medical Child Support Order
• Children up to age 26 for whom you are the legal guardian or for whom you have a court order awarding permanent custody
• Your adult child over age 26 who has a mental, physical, or developmental disability that renders them incapable of self‑support, provided the disability began before age 26

Please note: An individual cannot be covered as both a team member and a dependent. For example, if both you and your spouse work for AdventHealth, you cannot cover each other as dependents under the medical plan.

Evidence of insurability (EOI)

A review of your health history completed by the insurance carrier before certain insurance coverage can be approved. If EOI is required, you'll be asked to complete a health questionnaire, and your coverage will begin only after the carrier approves your application.

Explanation of benefits (EOB)

A statement from your health insurance carrier explaining how a medical claim was processed, including what the plan paid, what your provider billed and any amount you may owe. An EOB is not a bill.

Family and Medical Leave Act (FMLA)

A federal law that provides eligible team members with up to 12 weeks of job-protected leave in a rolling 12-month period for qualifying family and medical reasons.

Flexible spending account (FSA)

An account that lets you use pre-tax dollars for eligible medical or dependent care costs. This lowers your taxable income.

Formulary

The plan’s preferred drug list. Medicines on the list usually cost less than those not listed.

Guaranteed issue

The amount of insurance coverage you can elect without completing a health review, if you enroll when first eligible or during an eligible enrollment period.

Health insurance marketplace

A government-operated marketplace where individuals and families can shop for and enroll in health insurance plans, also known as the Exchange.

Health savings account (HSA)

A tax-advantaged account you can use to pay for eligible healthcare expenses now or save for future medical costs. You can contribute to an HSA only if you're enrolled in the Health Savings Plan. Unused funds roll over from year to year, and the account stays with you even if you change jobs or retire.

HIPAA (Health Insurance Portability and Accountability Act)

A federal law that protects the privacy and security of your health information and helps ensure your health coverage can continue under certain circumstances.

Hospital indemnity insurance

A supplemental insurance plan that pays a cash benefit for covered hospital stays and related services to help offset out-of-pocket expenses.

In‑network

Doctors, hospitals and clinics that have a contract with the plan. Using them usually costs less.

Inpatient

Care you get when you are admitted to a hospital and charged for room and board.

Life and AD&D insurance

Life Insurance provides a benefit to your beneficiary if you die while covered. AD&D Insurance pays an additional benefit if you die or experience certain qualifying injuries as the result of a covered accident.

Medically necessary or medical necessity

Care that is needed to diagnose or treat a condition based on accepted medical standards and the plan’s rules.

Medicare

A federal health insurance program primarily for individuals age 65 and older, as well as certain younger individuals with qualifying disabilities or medical conditions.

Medicaid

A joint federal and state program that provides health coverage to eligible individuals and families based on income and other qualifying factors.

Network

A group of approved providers and facilities who have contracts with the plan.

No Surprises Act

A federal law that protects you from many unexpected medical bills for emergency services and certain out-of-network care received at an in-network facility.

Open enrollment

The time each year when you can review and change your benefits for the next plan year.

Out‑of‑network

Care from providers who do not have a contract with the plan. For AdventHealth medical plans there is no coverage for out‑of‑network care except in emergencies. Use Tier 1 AdventHealth providers or Tier 2 Aetna network providers as shown in your plan to avoid higher costs.

Out‑of‑pocket maximum

The most you’ll pay in a year for covered care. After you reach this limit, the plan pays 100% of covered costs for the rest of the year.

Outpatient

Care you get without being admitted to a hospital.

Paid Parental Leave (PPL)

Paid time away from work available to eligible full-time team members to bond with a new child following birth, adoption or placement. AdventHealth provides four weeks of paid parental leave at 100% of base pay, subject to eligibility and policy requirements.

Paid time off (PTO)

Paid time away from work that eligible full-time and part-time team members can use for vacation, personal time, illness or other approved absences, in accordance with AdventHealth's PTO policy.

Participant

Anyone enrolled in the plan who can get benefits. This includes employees, dependents and COC beneficiaries.

Pre‑authorization

Approval the plan may require before certain services or medications are covered. Without approval, the plan may pay less or deny the claim.

Pre-tax deduction

A benefit deduction taken from your paycheck before taxes are calculated, which may lower your current taxable income.

Qualifying life event (QLE)

A life event that allows you to make changes to your benefits outside of Open Enrollment. Common examples include marriage, the birth or adoption of a child, loss of other coverage or a move. Benefit changes must generally be requested within 30 days of the qualifying life event.

Roth 403(b)

A retirement savings option that lets you contribute after-tax dollars to your 403(b) account. While contributions don't reduce your taxable income today, qualified withdrawals in retirement — including earnings — are generally tax-free.

Special Enrollment Period (SEP)

A window of time when you can make changes because of a qualifying life event.

Summary Plan Description (SPD)

The official document that explains your benefits in detail.

Tier 1 generic drugs

Generic medicines that usually have the lowest cost and co‑pays.

Tier 2 brand‑name drugs

Patented brand medicines that usually cost more than generics.

Tier 3 nonformulary or nonpreferred drugs

Brand medicines not on the preferred list. These usually have the highest co‑pays.

Tier 4 specialty drugs

Higher‑cost medicines used for complex conditions. These often have higher co‑pays.

Urgent care facility

A clinic that treats non‑emergency issues without an appointment.

Urgent care virtual visits

AdventHealth Urgent Care Virtual Visits are available in the following states: Colorado, Florida, Georgia, Illinois, Kansas, Kentucky, Missouri, North Carolina, Tennessee, Texas and Wisconsin.