Glossary

Actively at Work	Performing for wages that are regularly paid by the University, the material and substantial duties of your occupation at the usual place of work or at any alternate place of work required by the University.
Benefits-Eligible Employee	Generally, you are benefits-eligible if you are: Full-Time: your position is anticipated to exist for one year or longer and you are scheduled to work at least 35 hours per week. Part-Time: your position is anticipated to exist for one year or longer and you are scheduled to work 20 - 35 hours per week. You are not benefits-eligible if you are scheduled to work fewer than 20 hours per week or if your position is expected to exist less than one year.
Coordination of Benefits	A provision that prevents duplication of benefit payments when you or your Dependent(s) also have coverage through another group plan. Coordination of Benefits procedures also determines which plan pays first.
Copayment	A flat dollar amount you pay for a specific service.
Coinsurance	The portion of covered medical bills that you pay for necessary care, after you meet your Deductible.
Deductible	The portion of your medical expenses you pay before the plan begins to pay benefits.
Dependent Children	This includes natural, step- and legally adopted children and children placed in the home for adoption. This also includes grandchildren if you or your Domestic Partner is the legal guardian, claims the child for income tax and legal purposes, and lives with the child in a parent/child relationship. Coverage continues up to the child’s 23rd birthday if he or she is unmarried. If you have a mentally or physically disabled child who was covered under the plan before age 23, you can generally continue coverage for that child indefinitely. You are responsible for notifying the Benefits Office when your Dependent child marries or reaches age 23. If you do not, your child may lose his or her coverage, and you may pay for coverage at a higher rate than you should.
Dependents	Include your spouse, Domestic Partner and Dependent Children. The plan does not cover your parents, grandchildren (unless noted in the Dependent Children definition) or foster children. If you have questions about your eligible dependents, contact the Benefits Office.
Domestic Partners	Two individuals of the same gender who live together in a long-term relationship of indefinite duration, with an exclusive mutual commitment in which the partners agree to be jointly responsible for each other’s common welfare and share financial obligations. The partners may not be related by blood to a degree that would prohibit legal marriage in the state in which they legally reside and may not be married to any other person. Your Domestic Partner must be registered with the Benefits Office. Certain restrictions may apply if your Domestic Partner is not an Internal Revenue Code Section 152 Dependent.
Full-Time	Your position is anticipated to exist for one year or longer and you are scheduled to work at least 35 hours per week.
Home Health Care Agency	An agency or organization that provides a program of home health care and is either approved by Medicare, or is established and operated in accordance with licensing and laws and: Primarily be for providing skilled nursing and other therapeutic services in the home. Have policies established by one or more physicians and one or more registered graduate nurses to govern the services provided under the supervision of a physician or nurse. Have a full-time administrator. Maintains written medical records of services to patients. The staff includes at least one registered graduate nurse or care by such nurse is available. Employees are bonded and it provides malpractice and malplacement insurance.
Hospital	A facility (other than a rest home, resort, nursing home, convalescent home, place for custodial care or home for the aged) that provides medical care and treatment of the sick and injured on an inpatient basis. The facility must be accredited as a Hospital by the Joint Commission on Accreditation of Health Care Organizations; a Hospital, psychiatric Hospital or tuberculosis Hospital as defined by and eligible under Medicare; or provides operative surgery on the premises, continuously provides 24-hour nursing service supervised by a registered graduate nurse and maintains treats sick and injured under the supervision of a qualified physician.
Lifetime Maximum	The most each covered person can receive from the medical plan.
Medically Necessary Care	A specific health care or Hospital service that is necessary for the treatment or management of a medical symptom or condition, and is the most efficient and economical care that can be safely provided.
Out-of-Pocket Limit	A cap on how much you have to pay for your family’s covered medical expenses in a calendar year. After you reach the Out-of-Pocket Limit during a calendar year, the plan pays 100% of the rest of all covered expenses for that year.
Part-Time	Your position is anticipated to exist for one year or longer and you are scheduled to work 20 - 35 hours per week.
Primary Care Physician (PCP)	Manages all of your health care needs, including referrals to participating specialists.
Qualifying Change in Family Status	The specific situations when you may change your coverage level after Open Enrollment.
Prevailing Fee Schedule	The amount in-network professional providers in your area generally charge for a specific service.
Reasonable and Customary Charges	The amount facility providers in your area generally charge for a specific service.
Skilled Nursing Facility	A Skilled Nursing Facility that is eligible to receive payments under Medicare (except for a Skilled Nursing Facility that is part of a Hospital). Also includes an institution or distinct part of an institution that is operated in accordance with applicable laws; regularly engages in providing continuous 24-hour a day care under the supervision of a licensed physician during the post-acute and rehabilitative state of an injury or illness; maintains daily medical records for each patient; is authorized to administer medication to patients; and is not primarily a home for the aged, a hotel, a school, a custodial care facility or an institution for treatment of substance abuse or mental illness.

While this Summary Plan Description summarizes the major provisions of this plan, it does not provide you with every plan detail. The plan documents, which govern this plan, provide full details. If there are any discrepancies between this Summary Plan Description and the legal plan documents, the legal plan documents control.