2017 Aflac Incorporated Benefits Guide

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Glossary
annual enrollment – a period specified by Aflac during which
you may change the plan options and benefits in which you
are enrolled, as long as any change is consistent with plan
eligibility rules and federal regulations.
catch-up contributions – additional 401(k) contributions that
people age 50 or older can make after reaching the federal
limit on annual 401(k) contributions. Federal law permits
catch-up contributions to encourage people nearing retirement
to expand their retirement savings.
certificate of creditable coverage – a document that
verifies prior health care coverage.
copay or copayment – a fixed-dollar amount that you
pay each time you receive specified health care services or
prescription drugs.
covered service or covered expense – a service or supply,
or a charge for a service or supply, that is eligible for payment
under a plan.
coinsurance – the percentage of the cost that you or the plan
pays for a covered medical expense after you have met your
annual deductible.
deductible – the amount of covered expenses that you
are responsible to pay each calendar year before the plan
starts paying.
domestic partner – your same-gender or opposite-gender
domestic partner with whom you have registered under a
domestic partnership law or to whom you are married under a
same-sex marriage law. Registration or same-sex marriage may
be in any jurisdiction that legally allows domestic partnerships
or same-sex marriage. You must provide documentation of the
registration or same-sex marriage to the Benefits Department.
Employees seeking coverage for a domestic partner cannot be
legally married to an opposite-sex spouse.
eligible dependents – your lawful spouse, your registered
domestic partner and your child(ren) as defined under each
plan. See the specific plan sections of this guide for details.
explanation of benefits or EOB – a statement from your
health plan that explains the benefit calculation and payment
of medical services. An explanation of benefits lists charges
submitted, amount allowed, amount paid by the plan and any
balance owed by the patient.
Employee Retirement Income Security Act – known more
commonly as ERISA, enacted in 1974 to protect the interests
of employee benefits plan participants and their beneficiaries.
ERISA requires disclosure of financial and other plan
information to participants, sets standards of conduct for plan
fiduciaries, and provides for appropriate remedies and access
to the federal courts.
flexible spending account – an employee benefits program
that allows you to set aside untaxed money from your pay and
reimburse yourself for eligible health care and dependent “day
care” expenses. This allows you to spend the dollars that you
otherwise would have paid in income taxes. The accounts are
separate bookkeeping accounts.
formulary – a drug list used as a guide to determine the
amount of your copay for each prescription medication that
you purchase. Drugs listed in the formulary are typically
available to you at a lower copay than those that are not listed.
A formulary may also be called a preferred drug list.
generic drugs – prescription drugs that are chemically
equivalent to brand-name products and dispensed under their
generic chemical names, usually at a lower cost.
HMO or Health Maintenance Organization – a health care
delivery system that typically uses contracted primary care
physicians to coordinate all health care for enrolled participants.
An HMO coordinates your care and refers you to specialists and
hospitals. Covered services are usually paid in full after you pay
any required copay. No claim forms are required.
in-network – a group of medical, dental or vision care providers
who are members of a service administrator’s network. The
service administrator has a pricing arrangement with the group
that helps to hold down the cost of the services received.
inpatient – treatment in a hospital or facility for which a room
and board charge is made.
medically necessary or medical necessity – a health care
service or treatment that’s generally accepted in medical
practice as needed for the diagnosis or treatment of a
patient’s condition and that can’t be omitted without harming
the patient (as judged against generally accepted standards of
medical practice). Medical necessity is defined under the terms
of the Aflac Employee Health Plan.
Medicare – health insurance benefits provided under Title XVIII
of the Social Security Act of 1965 (Federal Health Insurance for
the Aged Act), as presently constituted or as amended.
medical emergency – a sudden, serious, unexpected
and acute onset of an illness or injury after which a delay in
treatment could cause irreversible deterioration resulting in a
threat to the patient’s life or a body part, or result in an organ
not returning to full, normal function.