Employee and Employer Health Benefits Glossary

Understand group health insurance basics and options for small businesses, HR managers, and employees to optimize benefits and costs.

Learn how GCHRA (Group Coverage HRA) works for small businesses, offering flexible health benefits while simplifying employer and employee responsibilities.

Learn what a Fully Insured Plan is and how it impacts small business owners, HR managers, and employees in health benefits choices.

Learn how full-time equivalent (FTE) employees are calculated, why the count matters for ACA rules, and how part-time hours affect employer obligations.

Learn what Full-Time Employee (FTE) means and how it affects small business benefits, compliance, and health insurance options.

Learn how Form 8941 applies to small business health benefits and how it affects employer and employee tax credits and reimbursements.

Learn everything small businesses need to know about Form 720 and its impact on employer-provided health benefits and compliance requirements.

Learn how Form 5500 affects small business health benefits plans and what employers need to know about this essential compliance document.

Learn what a Primary Care Provider (PCP) is, how PCP selection works, employer responsibilities, costs, and FAQs for employees and employers.

Learn when health plans require medical referrals, how they affect coverage and employer costs, and what employees should do before seeing a specialist.

Understand step therapy: how medication step requirements work, who they affect, and what to expect when plans require a different medication.

Learn how prior authorization works, what employers must budget and administer, employee responsibilities, and steps for requests, denials, and appeals.

A practical guide to specialty drug coverage: costs, prior authorization, pharmacy networks, HRAs, and employer compliance for group and individual plans.

Understand drug tiers, formularies, and how prescription costs affect employees and employers, plus disclosure duties, exceptions, and HRA impacts.

Understand health plan formularies: tiers, coverage rules, costs, employer obligations, and how to check drug coverage before choosing a plan.

Learn what network adequacy is, how it's measured, employer duties, employee steps to confirm coverage, and implications for costs and access.

Learn how provider directories work, employer responsibilities, costs, and how employees should verify in-network status to avoid surprise bills.

A CHOICE (Custom Health Option and Individual Care Expense) Arrangement, previously called an ICHRA, lets employers fund individual health insurance tax-free.

Understand narrow network health plans: how provider limits affect employers and employees, costs, enrollment, and what to verify before choosing coverage.