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Glossary of Health Care Terms

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Accidental Death & Dismemberment (AD&D) Coverage:

Insurance that pays money (pays a benefit) to a beneficiary if an accident causes the death of the insured person. A benefit may also be payable for the accidental loss of limb, sight, hearing and/or speech.

Beneficiary:

The person(s) named by you to receive any benefits provided by a Life Insurance and/or AD&D plan if you die. Benefits will be paid to the primary beneficiaries unless they have died before or at the same time or are unavailable. In this case, benefits will be paid to the contingent beneficiaries.

Brand-Name Drug:

Drugs developed and produced exclusively by a single pharmaceutical company. The formula for these drugs is protected by patent for a period of several years before a generic can be developed.

COBRAConsolidated Omnibus Budget Reconciliation Act of 1985:

Provides an opportunity for postdocs to temporarily continue health care coverage in a sponsored plan after their coverage normally would have terminated. The federal law allows postdocs leaving Stanford to continue the health insurance coverage they had when on assignment as a postdoc. You pay group premium rates plus a set administrative fee. Learn more about our COBRA coverage.

Coinsurance:

The percentage of the allowable amount or billed charges that the member must pay for covered services after meeting any applicable plan deductible.

Copayment:

The fixed dollar amount the member must pay covered services after meeting any applicable plan deductible.

Domestic Partner:

Postdoc’s domestic partner under a legally registered and valid domestic partnership. Domestic partner does not include any person who is: (a) covered as an insured employee; or (b) in active service in the armed forces. For a domestic partnership, other than one that is legally registered and valid, in order for the postdoc to include their domestic partner as a family member, the postdoc and domestic partner must meet the following requirements:

  • Both persons share a common residence.
  • Neither person is married to someone else or a member of another domestic partnership with someone else that has not been terminated, dissolved, or adjudged a nullity.
  • The two persons are not related by blood in a way that would prevent them from being married to each other in California, or if they reside in another state or commonwealth, that state or commonwealth;
  • Both persons are at least 18 years of age.
  • Either of the following:
    • Both persons are members of the same sex; or
    • One or both of the persons meet the eligibility criteria under Title II of the Social Security Act as defined in 42 U.S.C. Section 402(a) for old-age insurance benefits or Title XVI of the Social Security Act as defined in 42 U.S.C. Section 1381 for aged individuals. Notwithstanding any other provision of this section, persons of opposite sexes may not constitute a domestic partnership unless one or both of the persons are over the age of 62.
  • Both persons are capable of consenting to the domestic partnership.
  • Both partners must provide postdoc benefits with a signed, notarized, affidavit certifying they meet all of the requirements set forth in 2.a through 2.f above, inclusive.

As used above, "have a common residence" means that both domestic partners share the same residence. It is not necessary that the legal right to possess the common residence be in both of their names. Two people have a common residence even if one or both have additional residences. Domestic partners do not cease to have a common residence if one leaves the common residence but intends to return.

Deductible:

The amount you must pay out-of-pocket before benefits are paid. The amount is usually an annual amount.

Explanation of Benefits (EOB):

The statement sent to you by your health plan explaining the benefit calculation and payment of medical services that details the services rendered and the benefits paid or denied for each service. An EOB lists the charges submitted, the amount allowed, the amount paid and any balance owed as the patient's responsibility.

Formulary Drug:

List of prescription drugs approved for a health plan's prescription drug benefit. Formulary lists are available at Anthem's website or you can call Anthem's Customer Service number and request a copy.

Generic Drug:

A prescription drug that is chemically equivalent to a brand name drug dispensed under its generic chemical name. Generic drugs are cheaper versions of expensive brand name drugs with the same active ingredients, strength and dosage form.

In-Network Provider:

A doctor, dentist, hospital or other practitioner who has a contract with a health plan to provide services.

Long-Term Disability (LTD):

A disability lasting more than 90 days.

Non-Formulary Drug:

Any brand-name prescription drug that is not included in a particular health plan's list of approved formulary drugs.

Open Enrollment:

The time period each year (usually in November) when you have an opportunity to change your benefit elections. Examples of changes: switch from SHCA to Choice POS II or Choice POS II to SHCA; add dependent(s) to medical/dental if not enrolled in your plan. Changes you make during Open Enrollment take effect the following January 1.

Out-of-Network Provider:

A doctor, dentist, hospital or other practitioner who does not have a contract with a health plan.

Out-of-Pocket Maximum:

A dollar limit on the total amount that a member has to pay for many covered services in a calendar year, including the copayments, co-insurance and deducitble.

Physician:

Generally, a doctor that is categorized as a general practitioner, family practitioner, pediatrician, internist or OB/GYN.

Qualifying Life Events:

When changes happen in your work or personal life, your benefits may need to change too. If you’re eligible to make changes, you must make the change within 31 days of the date of your qualifying life event (e.g., gain a dependent child through birth, adoption or legal custody, spouse/partner loses coverage due to loss of job and now needs coverage through you). If you miss the 31-day deadline, you will have to wait until the next open enrollment period held typically in November.

Short-Term Disability (STD):

A disability lasting fewer than 181 days.

Specialist:

Generally, a doctor that is NOT categorized as a general practitioner, family practitioner, pediatrician, internist or OB/GYN. Examples of a specialist would include  a dermatologist or cardiologist.

Waiving Medical Coverage:

Stanford University requires that all postdoctoral scholars be covered by medical insurance. Some postdocs choose to waive the benefits offered through the Postdoctoral Services Office. Waiving the medical, dental and/or vision benefits means that you relinquish your option to enroll in the medical, dental and vision benefit plans offered through the postdoc benefits and obtain coverage through a different source (e.g., coverage through spouse/partner, individual policy). In order to waive medical coverage, you must provide proof that you are enrolled in another comprehensive medical plan. More info is here.