Benefit Definitions

CIGNA Open Access Plus (OAP) Coinsurance Plan with CIGNA Choice Fund HRA - A preferred provider organization with an employer owned health reimbursement account (HRA). The College deposits money into this account on your behalf to be used for eligible expenses as defined by the IRS Code Section 213 for covered individuals. Account balances roll over from year to year. Account is surrendered when employee leaves Saint Joseph's College.

CIGNA Open Access Plus (OAP) Coinsurance Plan with CIGNA Choice Fund HSA - A preferred provider organization with a health savings account (HSA). Both employee and employer can set money aside on a pre-tax basis to be used for eligible expenses as defined by the IRS Code Section 213 for covered individuals. Account balances roll over from year to year. Account remains with employee even when they leave Saint Joseph's College.

Coinsurance - The percentage of claim cost paid by the Plan.

Copay - Flat amount paid by employee at time of service.

Deductible - First dollars paid by the employee before the plan pays its coinsurance.

Deductible waived - Charge will be paid at coinsurance rate at time of service, not subject to a deductible.

Enhanced Preventive - Maintenance pharmacy covered at the rates listed in the Health Plan Overview.

FSA - An FSA or Flexible Spending Account is an account that employees can deposit pre-tax dollars into to cover eligible expenses. This allows you to save on these eligible expenses by the amount of taxes that you pay. The College offers a Medical Spending Account for eligible medical expenses and/or a Dependent Care Spending Account for eligible child and adult care expenses. This is an annual account. All money deposited in this account must be used for eligible expenses for the calendar year. Unused balances will be forfeited by the individual and revert to the health plan to cover costs.

HMO - A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract.

HRA - An HRA or Health Reimbursement Account is an account that is set up by the College in which it deposits money for you to cover eligible medical expenses. This account is paired with the PPO ($1250/$2500 deductible) health plan. The College will deposit $625 for singles and $1500 for family plans. It will also be used to deposit Wellness incentive money for participants in this health plan. The benefit of an HRA over the FSA is that the money will roll over from year to year. It will be available to you as long as you are an active employee of the College.

HSA - An HSA or Health Savings Account is an account that employees set up. Both you and the College can deposit pre-tax dollars into this account to cover eligible health care expenses. The College will deposit $450 for single and $900 for family plans. It will also be used to deposit Wellness incentive money for participants in this health plan. Unlike the HRA or FSA, this is your personal account and can be used after you leave the College. This account must be paired with a Qualified High Deductible Health Plan (QHDHP). At SJC the qualified high deductible health plan is our PPO ($2,500/$5,000 deductible) plan.

In-Network - Services obtained with a CIGNA provider.

Out-of-Network - Services obtained through a Non-CIGNA provider.

Out-of-Pocket Maximum - The most an employee/family will pay in out-of-pocket expenses in any plan year.

PPO - A preferred provider organization (PPO) is a subscription based medical care arrangement. A membership allows a substantial discount below their regularly charged rates from the designated professionals partnered with the organization. Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers.

Preventive - annual physical exam.