Group Health Insurance Glossary
Plain-English definitions for the terms brokers, carriers, and renewal notices throw at you — so you can walk into your next benefits conversation informed.
Compliance & Regulation
ACA Employer Mandate
The Affordable Care Act requirement that applicable large employers (generally 50+ full-time-equivalent employees) offer affordable, minimum-value health coverage or face potential penalties.
COBRA
A federal law that lets employees (and their dependents) temporarily keep their employer group health coverage after certain qualifying events, like job loss, by paying the full premium themselves.
ERISA
The federal law that sets minimum standards for most employer-sponsored group health and retirement plans, including reporting, disclosure, and fiduciary duties.
Cost-Sharing & Accounts
Coinsurance
The percentage of a covered medical bill an employee pays after meeting their deductible, with the plan covering the rest.
Deductible
The amount an employee must pay out-of-pocket for covered services before the health plan starts sharing costs.
FSA (Flexible Spending Account)
An employer-sponsored account that lets employees set aside pre-tax dollars for eligible medical or dependent-care expenses, generally used within the plan year.
HDHP (High-Deductible Health Plan)
A health plan with a higher annual deductible than a traditional plan, usually paired with lower premiums and HSA eligibility.
HSA (Health Savings Account)
A tax-advantaged savings account, available only to people enrolled in a qualifying high-deductible health plan, used to pay for eligible medical expenses.
Plan Types & Funding
Fully Insured Health Plan
The traditional model — the employer pays a fixed monthly premium to a carrier, and the carrier assumes all financial risk for paying claims.
ICHRA (Individual Coverage Health Reimbursement Arrangement)
A benefit structure where an employer gives each employee a fixed monthly allowance to buy their own individual health insurance policy, instead of offering one group plan.
Level-Funded Health Plan
A hybrid funding model where the employer pays a fixed monthly amount that covers expected claims, admin fees, and stop-loss insurance — with a potential refund if claims come in lower than projected.
PEO (Professional Employer Organization)
A firm that enters a co-employment arrangement with a business, bundling payroll, HR administration, compliance, and access to large-group health benefits.
Self-Funded Health Plan
A plan where the employer directly pays employee health claims out of its own funds, rather than paying a fixed premium to an insurance carrier.
Stop-Loss Insurance
A backstop insurance policy that reimburses a self-funded or level-funded employer once claims exceed a pre-set dollar threshold.
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