Employee and Employer Health Benefits Glossary

Understand provider networks, in-network vs out-of-network care, employer impacts, and steps employees should take when choosing health coverage.

Learn what a Member ID Card shows, how employees use it, employer responsibilities, and what to do if a card is missing or incorrect.

Learn who the policyholder is in health insurance, how it affects employers and employees, and key rules for CHOICE (ICHRA), QSEHRA, COBRA, and compliance.

Learn what a health insurance subscriber is, who can be one, how it differs from dependents, employer duties, costs, and common mistakes.

What is effectuated coverage, when does individual health insurance begin, and how employers should verify coverage for CHOICE (ICHRA)/QSEHRA reimbursements.

How health insurance premium grace periods affect employers and employees — Marketplace rules, COBRA, HRAs, payment risks, and steps to avoid coverage gaps.

Understand how auto-reenrollment (passive renewal) affects employer and Marketplace health benefits, compliance, payroll, and what employees must review.

Understand binder payments — how the first premium activates coverage and what employers and employees must do with CHOICE (ICHRA) and QSEHRA reimbursements.

Understand grandfathered health plans: which ACA rules apply, how status is maintained or lost, employer duties, and employee considerations.

Learn how guaranteed renewability protects health coverage, its exceptions, employer duties, employee rights, renewal costs, and key deadlines.

Learn what actuarial value means, how metal tiers work, employer obligations, and what to compare when choosing employee health coverage.

How Benchmark Plans (Marketplace reference plans and state EHBs) affect premium tax credits, CHOICE (ICHRA) affordability, and employer compliance.

How the Second Lowest Cost Silver Plan (SLCSP) sets premium tax credits and affects CHOICE (ICHRA), QSEHRA, employer obligations, and coverage choices.

How Cost-Sharing Reductions lower out-of-pocket costs, who qualifies, employer impacts (CHOICE/ICHRA and QSEHRA), common mistakes, and next steps.

Learn how health care sharing ministries differ from insurance, plus employer tax/compliance impacts and employee risks, costs, and enrollment considerations.

Understand fixed indemnity plans: scheduled cash benefits, limits, employer legal/tax implications, and what employees should verify before enrolling.

Understand STLDI: coverage limits, employer compliance duties, payroll impact, and when short-term plans are (or aren't) appropriate.

Learn differences between on- and off-exchange health plans, who qualifies for subsidies, and employer HRA rules for reimbursing individual coverage.

Learn how tobacco surcharges affect employer and individual health plans—who may pay, legal limits, alternatives, payroll impact, and compliance steps.