Common Vocabulary and Terms
Use the links below to jump to a section covering common vocabulary and terms:
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We would like to thank Marianne McIvor, Health Care Facilitator for UCSC, and Frank Trueba, retired Benefits Manager from UCSC, for collaborating on this resource page with the Retiree & Emeriti Center.
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Health & Welfare Plans: Common Vocabulary and Terms
The difference between a plan and a provider
A plan is an insurance plan. Expenses are paid for according to plan design, described in the annually issued plan booklet. Plan design can change from year to year. For example, the deductible amount, percentage of cost covered by the plan, services/treatments excluded and included under coverage, etc, can change from one year to the next. Changes in plan design for the following year are announced during Open Enrollment.
A provider is a care provider, such as a doctor, hospital or other out-patient facility, who may or may not accept specific plans.
Network
Network simply means the providers that have contracted with the insurance plan to provide care. Care providers that are in-network are contractually obligated to bill to a plan on the patient's behalf and cannot charge more than the agreed upon rates for any service. The plan network of providers can be a primary factor in deciding upon which plan is best for you and your family. In-network care is less expensive than out-of-network care. Out-of-network providers can charge more for services than in-network providers. Many insurance plans provide no coverage for out-of-network care.
Health Maintenance Organization (HMO)
A Health Maintenance Organization (HMO) is a closed network model of delivering services. Primary Care Physician in concert with the Medical Group coordinate authorizations for specialty care, referrals, hospital admissions within prescribed network of providers. Out of network services, except for emergency treatment will normally not be covered by the plan.
Preferred Provider Organization (PPO)
Preferred Provider Organization (PPO)s are in-network providers that are under contract to provide care and can only charge according to contracted rates. UC's PPO plans also offer access to Out of Network (OON) providers at a greater expense. Annual Maximum Out-of-Pocket limits provide some protection, however members are motivated by cost and billing reimbursement processes to Preferred Providers.
Select Providers Specific to UC Care Plan ONLY
(per current plan design and into 2022)
The UC Select providers are contracted by University of California specifically and only exist in areas near UC campus locations. UC Care Select Providers are a subset of Preferred Providers that provide some specific services at a deeper discount for the member than Preferred Providers, at the direction of UC. UC Care Select provider network includes: UC Medical Centers and Palo Alto Medical Foundation, Santa Cruz providers (but not all PAMF providers) and Dignity Health, Santa Cruz providers (but not all Dignity Providers).
Coordination of Benefits (COB)
Coordination of Benefits (COB) is the US healthcare industry strategy for determining "which plan pays first", or Primary Coverage.
COB only applies when an individual is covered by more than one insurance plan. For example, if you are covered by UC medical (your employer) and your spouse covers you under their employer-sponsored insurance plan; in this case, UC's coverage is Primary and coverage as a dependent on your spouse's plan is Secondary. COB also applies when someone has Medicare in combination with UC coverage. Medicare is an insurance plan. Generally, Medicare is Primary coverage for a Medicare-eligible individual.
Medicare Advantage
Medicare Advantage Plans are a type of Medicare health plan offered by a qualified medical insurance company that contracts with Medicare to provide all your Part A and Part B benefits and often prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Generally, only care received from a provider that accepts Medicare will be covered. Your services are not paid for by Original Medicare because part of electing coverage in Medicare Advantage plan is assigning your Medicare benefits to the insurance plan.
Examples offered by UC: UC Medicare Choice, Kaiser Senior Advantage.
Medicare Supplement
Medicare Supplement plans are insurance plans that pays some for charges not covered by Medicare Part A & B. Some provide prescription drug coverage. Generally, only care received from a provider that accepts Medicare will be covered. Medicare pays first (Primary coverage) then the Medicare Supplement Plan pays after Medicare for covered services.
Mixed Medicare Coverage
Mixed Medicare coverage applies only to retirees, not employees. When at least one family member is eligible and covered by Medicare, while other family member(s) is not covered by Medicare. For example, a retiree is over age 65 and their spouse is under 65 years old.
Medicare Coordinator Program
The Medicare Coordinator Program (currently Via Benefits) is UC's strategy for providing medical coverage for retirees that live in US, but outside of California. When all family members are Medicare-eligible and live out-of-state, UC will move the family to the Medicare Coordinator Program. This program does not effect retiree dental or legal coverage.
Via Benefits
UC's current vendor partner for administering the Medicare Coordinator Program, for out-of-state UC retirees where all covered individuals are Medicare-eligible.
Dental
Dental continues into retirement if you elect monthly retirement income and elect to continue coverage. Monthly premiums may be partially or wholly paid by UC.
Vision
Vision coverage as an employee ends with separation/retirement. If you elect monthly retirement income, the vision plan can be continued by enrolling and paying a monthly premium directly to the plan. Premiums may not be auto-deducted from pension income.
Legal
Legal coverage continues into retirement if you elect monthly retirement income and elect to continue coverage.
Life Insurance
Life Insurance coverage ends with separation from employment, even if you are eligible for UC retiree health coverage. University-paid and employee-paid life insurance coverage may be converted to an individual whole life policy without a medical exam. Employee-paid life insurance coverage provides a portability provision for group term life insurance, with restrictions. Employees and dependents may convert coverage or apply for portable coverage, but may not do both. You must submit an application and the required premium to The Prudential Insurance Company within 31 days from the date your coverage ends. If you decide to purchase coverage, please request the Notice of Group Life Conversion form or the Portability Election Form as applicable. Please review premiums rates at Prudential website prior to requesting conversion/portability application.
Flexible Spending Account (FSA)
Participation ends with separation/retirement. COBRA continuation will be offered without tax benefits, but may be useful for receiving reimbursement of YTD contributions. Participation in FSA from pension income not allowed under IRS regulations.
Survivor: Common Vocabulary and Terms
Terms below refer to when a member of the UC has passed.
Survivor & Beneficiary Handbook
For family members and beneficiaries of UC Retirees and Disabled Members receiving UCRP income. The handbook is a good reference tool for retirees planning for the inevitable:
Survivor
Determined by UCRP pension plan. An individual eligible to receive any portion of pension benefits following the death of a member of the UC Retirement Plan.
Examples: An eligible surviving spouse; eligible child, eligible domestic partner.
Contingent Annuitant
Irrevocably elected at the time of retirement by the UCRP member. Member elects to receive a reduced monthly, lifetime income in order to provide, upon death, a monthly lifetime income to the Contingent Annuitant. Factors in reduced UCRP member income and Contingent Annuitant based upon(age & gender) actuarial data for both member and named Contingent Annuitant. A Contingent Annuitant can be only one, living person and cannot be a Trust nor multiple people.
Obtain estimates using UCRAYS. Log in at https://retirementatyourservice.ucop.edu/UCRAYS
Beneficiary
An individual or trust named by the member prior to death to receive a benefit payment. Can be changed at any time.
Designate beneficiary(ies) for life insurance, accidental death and UCRP at UC RAYS https://retirementatyourservice.ucop.edu/UCRAYS
Designate beneficiary(ies) for 403b, 457b, Defined Contribution Plan at Fidelity Retirement Services, https://www.netbenefits.com
Dependent
Any family member, other than the employee, covered by UC-sponsored insurance plan.
Taxes and Financial: Common Vocabulary and Terms
As part of the retirement process, you will be requested to state your Federal & State tax withholding for your pension income. Withholding elections may be changed at any time on UCRAYS.
UC Pension Income Statement Abbreviations
ER is an abbreviation for “Employer”, in other words the University of California (UC). The ER amount is what UC contributes towards the premium cost of your coverage.
MBR is an abbreviation for “Member”, in other words you. The MBR amount is what is deducted from your pension income and applied towards the premium cost.
Rollover
Transfer of retirement savings from one account to another, per IRS specifications. Considered a non-taxable event.
Contact Fidelity Retirement Services for assistance at 800-558-9182.
Minimum Required Distribution (MRD)
IRS-mandated distribution from retirement savings (403b, 457b, Defined Contribution Plan). Failure to comply will result in penalties. UC cannot "override" IRS requirements. See also the Minimum Required Distribution Factsheet: https://ucnet.universityofcalifornia.edu/forms/pdf/minimum-required-distributions-fact-sheet.pdf
Contact Fidelity Retirement Services for assistance at 800-558-9182.
Capital Accumulation Program (CAP)
Capital Accumulation Program. Offered to specific members of UCRP in 1990's and 2000's as deferred compensation in lieu of wage increases. Must be distributed from UCRP at the time of retirement. Members may choose to receive whole or partial distribution (cash out) or whole or partial rollover.
