Health Insurance Glossary

A formal request to have a denied or partly paid claim reviewed again. You usually send a letter explaining the issue with any supporting documents, which starts the appeals process.

A short list of questions to answer to assess if you are suitable to work for an employer like LifeX

When an out-of-network provider bills you for the difference between their price and what your plan paid. Learn more: In-Network vs Out-of-Network

The people who take part in Bright Life research. They are hired as W-2 employees, receive a W-2, and pay tax on what they earn. Learn more: Bright Life

A federal law that can let you keep an employer's group health coverage for a limited time after losing eligibility, for example after leaving a job or aging off a parent's plan at 26. You typically pay the full cost yourself. Learn more: Between Jobs

Your percentage share of a covered bill after you meet your deductible, such as 20%. Learn more: What Will You Actually Pay?

A fixed amount you pay for a covered service, such as a doctor visit or prescription. Copays usually do not count toward your deductible. Learn more: What Will You Actually Pay?

The amount you pay for covered care each year before your plan starts sharing the cost. Learn more: What Will You Actually Pay?

A secure online portal where enrolled employees can view their medical ID cards, complete wellness activities and surveys, and check plan information and claims from any device. Adult dependents need their own login for privacy reasons. Learn more: LIFE X · Bright Life

Health coverage an employer offers to its employees, often with the employer sharing the cost. Learn more: Self-Employed or 1099?

A plan that covers in-network care only, except emergencies, and usually doesn't require referrals. Learn more: In-Network vs Out-of-Network

The Employee Retirement Income Security Act, the federal law that sets standards for most employer-sponsored benefit plans, including self-funded health plans.

An employer account you fund with pre-tax pay for medical costs. Most unused money is lost at year end. Learn more: HRA vs HSA vs FSA

The list of prescription drugs a plan covers. Each plan has its own formulary, so check the one tied to your specific plan for coverage limits.

An employer-funded account that pays you back for qualified medical costs, under rules your employer sets. Learn more: HRA vs HSA vs FSA

A questionnaire about your health, habits and history that helps estimate health risks and point you toward preventive steps.

A personal, tax-advantaged savings account for medical costs, paired with an HSA-eligible plan. The balance is yours to keep. Learn more: HSA Basics

A plan with a higher deductible and usually lower premiums. Many qualify you to open an HSA. Learn more: HSA Basics

A plan that covers in-network care only, except emergencies, and usually requires referrals to see specialists. Learn more: In-Network vs Out-of-Network

Doctors, hospitals and labs that have agreed to discounted prices with your plan. Learn more: In-Network vs Out-of-Network

A short set of eligibility questions to assess whether you qualify for certain coverage. Answer them honestly and based on your own situation.

The government-run site where you can buy an individual health plan and see if you qualify for help with premiums. Learn more: Self-Employed or 1099?

The group of providers your plan has contracted with. Learn more: In-Network vs Out-of-Network

The yearly window when you can sign up for or change a health plan. Learn more: Missed Open Enrollment?

Providers that don't contract with your plan. Using them usually costs more. Learn more: In-Network vs Out-of-Network

The most you'll pay for covered in-network care in a year. After that, the plan pays 100%. Learn more: What Will You Actually Pay?

The company that manages a plan's prescription benefits, including the formulary, pharmacy network and mail-order options.

The provider network for LifeX plans, with MagnaCare in NY and NJ. Learn more: LIFE X

A plan with a network that also covers some out-of-network care at a higher cost, usually without referrals. Learn more: In-Network vs Out-of-Network

Approval from your plan before certain services, such as a surgery or hospital stay.

What you pay each month to have coverage, whether or not you use care. Learn more: What Will You Actually Pay?

Checkups, screenings and vaccines that many plans cover at no cost when you use an in-network provider. Learn more: What Preventive Care Is Covered at 100%?

A change in your life that affects your health coverage, such as losing other coverage, marriage, or a new child. A QLE can let you change coverage outside open enrollment. Learn more: Missed Open Enrollment?

A licensed agent, contracted and certified, who educates potential associates about a program and guides them through enrollment. Learn more: Become a broker / agent

An employee of a health data and research organization who voluntarily takes part in wellness activities and health data collection. Research Associates are W-2 employees and receive access to the employer's health benefit plan as part of their employment. Learn more: LIFE X

A health plan where the employer pays claims directly instead of buying a fully insured policy from an insurance company. These plans are usually run by a Third-Party Administrator and governed by ERISA.

A window, often 30 to 60 days after a qualifying life event, when you can enroll in or change a plan. Learn more: Missed Open Enrollment?

A standard document that explains in plain language what a plan covers, what you pay, and key limits. Use it with the full plan documents for exclusions.

A doctor visit by video or phone instead of in person. Learn more: $0 Telemedicine

A company hired to run a self-funded plan's day-to-day work, such as processing claims, issuing ID cards and answering member questions.

Someone hired as an employee, who receives a W-2 and has taxes withheld from their pay. Learn more: Self-Employed or 1099?

The time after your coverage starts before certain benefits can be used. Some plans apply a waiting period to elective surgeries.

A self-employed contractor or freelancer who receives a 1099 instead of a W-2. Learn more: Self-Employed or 1099?