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Glossary

Aetna International

Administrator for health benefits available to plan members and their eligible family members who reside outside the United States and are sponsored by ELCA Global Mission.

Affordable Care Act

Signed into law March 23, 2010, the Patient Protection and Affordable Care Act offers comprehensive health reform. Some key health coverage provisions of the law include an expansion of Medicaid eligibility, the creation of health insurance exchanges through which eligible individuals are able to purchase insurance with premium and cost-sharing credits, regulations that prevent health insurers from denying coverage to people, the requirement that most individuals have health insurance beginning in 2015, and penalties to large employers that don't offer affordable coverage to their employees.

Annual enrollment

The annual time period when sponsoring employers and plan members are required to make certain benefit decisions for the coming year.

Basic group life insurance

Employer-paid group life insurance that provides a benefit between $6,000 and $50,000.

Buy up

When ELCA Health Plan members purchase a higher-priced ELCA-Primary health benefit option than the option their sponsoring employer selected during Annual Enrollment, and pay the cost difference through payroll deduction.

Coverage

Describes which family members are covered by the ELCA Health Plan. Sponsored plan members can elect to change coverage for themselves and family members during Annual Enrollment or when they enroll in the plan. Coverage categories are:

  • Plan member
  • Plan member and children
  • Plan member and spouse or ESGP
  • Plan member, spouse or ESGP, and children
  • Waived self and family

Coverage continuation cost

The cost a coverage continuation plan member pays to be covered in the ELCA Health Plan, based on age and health benefit option chosen, and billed to the plan member monthly.

Coverage continuation members

Individuals who previously received ELCA benefits from a sponsoring employer but now purchase ELCA benefits at their own expense. Includes ELCA Health Plan members who are retired, on leave from call, and separated from service, as well as surviving spouses or ESGPs, former spouses, and other eligible family members. Eligibility rules apply.

Contributions

See Employer contributions and Plan member contributions.

Copayment

A fixed dollar amount that ELCA Health Plan members with certain health benefit options pay for certain eligible health care services, such as prescription drugs, usually when the services are received.

Deductible

The annual amount that ELCA Health Plan members pay for certain eligible health care services during the year before the plan pays anything.

Dependent (day) care flexible spending account (FSA)

A tax-advantaged account that allows ELCA Flexible Benefits Plan members to set aside pretax dollars for eligible dependent care (such as day care) expenses that enable the member and spouse to work or seek work. Money not used by the end of the year is forfeited.

Dependent life insurance

Optional group life insurance that sponsored plan members can purchase on the life of their spouse or ESGP and children, if they also purchase supplemental life insurance for themselves.

Discount programs

Discount opportunities that Portico is able to offer due to the collective buying power of ELCA plan members. Discount programs include fitness center and hearing discounts, and long-term care insurance.

ELCA Church Council

The board of directors of this church that serves as the interim legislative authority between meetings of the Churchwide Assembly. Includes the Presiding Bishop, Vice President, Secretary, Treasurer, Chair of the Conference of Bishops, and 33 to 45 people elected by the Churchwide Assembly.

ELCA Medicare-Primary Health Benefits

Health benefits available to ELCA Health Plan members and their eligible family members who are age 65 and over (unless sponsored by an organization with 20 or more employees); also includes those under age 65 where Medicare is the primary payer due to a disability. Includes three health benefit options: Premium, Standard, and Economy. However, members who are sponsored by an employer, on leave from call, living outside the United States, or receiving ELCA disability benefits are eligible for the Standard option only.

ELCA Philosophy of Benefits

A document describing the ELCA’s perspective on benefits intended to help organizations, rostered leaders, and other church employees make benefit decisions in alignment with ELCA values. Revised and approved by the ELCA Church Council in 2013.

ELCA-Primary Health Benefits

Health benefits available to ELCA Health Plan members and their eligible family members who are under age 65 except those receiving primary Medicare coverage due to a disability; also includes those age 65 and over who are sponsored by an organization with 20 or more employees. Includes a choice of four health benefit options: Platinum+, Gold+, Silver+, and Bronze+.

Employer contributions

Amounts that employers pay to sponsor their eligible employees in the ELCA benefits program, including health, retirement, housing equity, disability, survivor, and retiree support contributions. May also include contributions to their plan member's health savings account (HSA), or housing equity contributions to their plan member's retirement account.

Employer health benefit contribution
The amount a sponsoring employer contributes to sponsor a plan member (and any eligible covered family members) in the ELCA Health Plan (either ELCA-Primary or ELCA Medicare-Primary). The contribution rate for each plan member is calculated annually based on geographic location, total defined compensation, health coverage level, and plan member age. Billed monthly.

Employer HSA contribution
The annual amount a sponsoring employer chooses to contribute to sponsored plan members’ health savings accounts (HSA) when the employer offers either the Silver+ or Bronze+ health benefit option. The sponsoring employer chooses one of three contribution levels and is billed monthly:
Level A: $1,200 single or $2,400 family (annual amount, billed monthly)
Level B: $600 single or $1,200 family (annual amount, billed monthly)
Level C: $-0- single or $-0- family

Sponsoring employers can also make a one-time HSA contribution to their sponsored plan member's HSAs. This one-time contribution is elected during Annual Enrollment and applies to sponsored plan members as of Jan. 1.

Employer-provided housing
When a sponsored plan member (typically rostered clergy) lives in housing that is paid for by the employer, such as a parsonage or a camp director’s on-site house. If no housing is provided, the sponsored plan member's total defined compensation is equal to total cash compensation plus 30% of base salary and social security tax allowance.

Employer retirement contribution
The amount a sponsoring employer contributes to a sponsored plan member’s retirement account. The maximum contribution is determined by IRS limits and compliance rules. Billed monthly.

Housing equity retirement contributions
Additional contributions a sponsoring employer makes to the retirement plans of clergy living in employer-provided housing, who do not have the opportunity to build equity in their home. Housing equity retirement contributions provide a tax-advantaged way for employers to support plan members who will eventually move out of employer-provided housing — when they retire or move to a new call without a parsonage, for example. They become part of the plan member’s retirement account balance. These funds and their earnings enjoy a special flexibility: they can be withdrawn at any time, and when used to purchase a home, they are often excluded from taxable income.

Disability contribution
The amount a sponsoring employer contributes to sponsor a plan member in the ELCA Disability Benefits Plan.

Survivor contribution
The amount a sponsoring employer contributes to sponsor a plan member in the ELCA Survivor Benefits Plan by providing basic group life insurance. Billed monthly.

Retiree support contribution
The amount a sponsoring employer contributes to help provide health coverage for currently retired members who served one of the ELCA-predecessor church bodies. Billed monthly.

ESGP

An eligible same gender partner (ESGP) is an individual who, together with a member of the ELCA benefits program, completed and signed an Affidavit of Partnership attesting that they are financially interdependent (share financial obligations), not married to or legally separated from anyone else, and live in a publicly accountable, lifelong, monogamous, same-gender relationship.

Evidence of Insurability (EOI)

Proof of good health, submitted through an application process in which ELCA Survivor Benefits Plan members provide information on their health or their dependent’s health to be considered for supplemental or dependent life insurance. EOI may be required to purchase or increase insurance coverage outside of a member’s initial eligibility, or a qualified family status change.

Flexible spending account (FSA)

See Health flexible spending account (FSA), limited-purpose health flexible spending account (FSA) and Dependent care flexible spending account (FSA).

Formulary

A list of both generic and preferred drugs maintained by a prescription drug benefit administrator. Formulary prescription drugs generally cost ELCA Health Plan members, and the plan, less than non-formulary drugs.

Health flexible spending account (FSA)

A tax-advantaged account that allows ELCA Flexible Benefits Plan members to set aside pretax dollars for eligible health care expenses. Money not used by the end of the year is forfeited.

Health insurance exchange

An online marketplace where individuals can buy health insurance. Created by the Patient Protection and Affordable Care Act of 2010. Each state has one either operated by that state, the federal government, or a state-federal partnership.

Health savings account (HSA)

A tax-advantaged account that allows eligible plan members and sponsoring employers to set aside pretax dollars for eligible health care expenses. Money in an HSA earns interest, is not forfeited at year-end, and is the member’s to keep even if he or she leaves the ELCA health plan.

High deductible health plan (HDHP)

Health coverage that meets specific IRS rules for deductible and out-of-pocket expenses. The ELCA-Primary Silver+ and Bronze+ health benefit options qualify as HDHPs. Only plan members who are covered by an HDHP can contribute to a health savings account.

Limited-purpose health flexible spending account (FSA)

A limited-purpose FSA allows sponsored plan members to set aside pretax money to pay for eligible dental, vision, and post-deductible medical, mental health, prescription drug expenses, and other eligible health care expenses. Sponsored plan members who are eligible for an HSA are also typically eligible for a limited-purpose FSA.

Long-term care

Skilled and/or custodial care services for people who develop disabilities or chronic care conditions that cause them to need assistance when walking, getting dressed, eating, or bathing.

Long-term care insurance

Insurance policy that covers skilled and/or custodial care services in a variety of settings including at home, in assisted living facilities, and skilled nursing facilities. Long-term care insurance can help people protect their assets and maintain their independence should they need this type of care in the future.

Marketplace

Another word for health insurance exchange; see above.

Metallic plans

Refers to the platinum, gold, silver, and bronze categories of plans on the health insurance exchanges. ELCA-Primary health benefit options are called Platinum+, Gold+, Silver+, and Bronze+ because they are designed to compare to the metallic plans by providing all the basics required of exchange plans, plus (+) broad provider networks, dental benefits, a fitness center discount, health support programs, and wellness incentives.

Multiple employments

When a plan member works for two or more employers that each sponsor him or her in the ELCA benefit program.

Network

The facilities, providers, and suppliers contracted by a health benefit administrator to provide health care services at negotiated rates. Plan members may seek care from the provider of their choice. Costs may be lower at in-network providers.

Out-of-pocket limit

The maximum annual amount that plan members pay for certain eligible health care services before the health plan starts to pay 100%.

Personal wellness account

Legally, a health reimbursement arrangement into which eligible health plan members, spouses, and eligible same gender partners can earn wellness dollars to pay for eligible health care expenses.

Plan member buy-up cost

Amount that ELCA Health Plan members pay through payroll deduction to purchase a higher-priced ELCA-Primary health benefit option than the option their sponsoring employer selected during Annual Enrollment.

Plan member contributions

Amounts that plan members pay to contribute to their health and dependent (day) care flexible spending accounts (FSAs), health savings accounts (HSAs), and pretax retirement accounts.

Rate class

One component in determining a sponsoring employer’s health contribution rate. Rate classes are geographic designations that represent regional differences in health care costs. Sponsoring employers are assigned a rate class according to the synod in which they are located.

Self-insured

A type of employer-provided benefit plan that covers its own risk rather than insuring that risk through a commercial insurance provider. The ELCA health and disability plans and the retiree survivor benefit are self-insured. While Portico may contract with third-party administrators to process claims, Portico pays the entire cost of all our claims by pooling contributions from sponsoring employers. In the case of health claims, ELCA plan members also cover some of the risk by paying deductibles and other out-of-pocket costs. Self-insured plans generally cost less than fully-insured plans due to fewer fees and the absence of sales commissions.

Simplified underwriting

Applying for long-term care insurance with an application that has fewer health questions than the full underwriting application. Simplified underwriting is available for a limited time to ELCA plan members who meet certain criteria.

Sponsored couple

When a plan member and spouse or ESGP are each employed by a sponsoring employer that provides ELCA benefits.

Sponsored plan members

Individuals who are called or employed by an eligible organization and receive ELCA benefits provided by that organization. Includes pastors, rostered laypersons, and lay employees. Eligibility rules apply.

Sponsoring employer

An employer who sponsors employees in the ELCA Pension and Other Benefits Program.

Supplemental life insurance

Optional group life insurance that ELCA Survivor Benefits Plan members can purchase on their own life to supplement the basic group life insurance benefit provided by their sponsoring employer.

Tax-advantaged account

A financial account that allows the owner to receive special tax treatment by federal and most state laws for the purpose of tax savings. Contribution and withdrawal rules vary by the type of account. The ELCA benefits program offers the following types of tax-advantaged accounts: personal wellness account (health reimbursement arrangement), health flexible spending account (FSA), limited-purpose health flexible spending account (FSA), health savings account (HSA), and dependent (day) care flexible spending account (FSA).

Total cash compensation

Includes the cash elements of an employee’s total defined compensation: base salary, Social Security tax allowance, housing allowance, and furnishings and utilities allowance.

Base salary
A type of cash compensation included in an employee’s total defined compensation for determining benefit contributions. Includes all salary, hourly wages, and overtime pay. See Total cash compensation.

Social Security tax allowance
A type of cash compensation included in a sponsored plan member's total defined compensation for determining benefit contributions. Ordained clergy are typically treated as employees for income tax purposes, but treated as self-employed for purposes of paying self-employment (SECA) taxes. Many organizations provide clergy with a Social Security tax allowance that reflects the employer portion of FICA taxes that would have been paid if the pastor were a lay employee instead. (See your synod’s compensation guidelines for more details).

Housing allowance
A type of cash compensation included in a sponsored plan member's total defined compensation for determining benefit contributions. For clergy (and some rostered lay people), it's the portion of their cash compensation designated in advance as a housing allowance, according to IRS rules. The designation allows tax filers to exclude these dollars from their taxable income, to the extent they meet other tax rules.

Furnishings and utilities allowance
A type of cash compensation included in a sponsored plan member's total defined compensation for determining benefit contributions. For some clergy (and some rostered lay people) who live in employer-provided housing, it's the portion of their cash compensation designated in advance as a furnishing and utilities allowance, according to IRS rules.The designation allows tax filers to exclude these dollars from their taxable income, to the extent they meet other tax rules.

Total defined compensation

Base salary plus any housing allowance, Social Security allowance, and furnishings and utilities allowance. For employees living in employer-provided housing (such as a parsonage), defined compensation is also increased by 30% of salary and Social Security allowance. These amounts are calculated prior to any payroll deductions.

Underwriter

In the insurance industry, a financial professional that evaluates the risk of insuring a particular person and uses that information to set premium pricing for insurance policies.

Underwriting

The process of reviewing medical and health-related information furnished in an insurance application process to determine if the applicant presents an acceptable level of risk to be considered insurable under the insurance program.

Waive

A plan member qualifies to waive ELCA health coverage if he or she has other valid health coverage, such as through a spouse's or ESGP's employer, or receives a subsidy on a state, federal, or state/federal partnership individual health insurance exchange and purchases the subsidized coverage through the individual exchange.

Wellness dollars

Financial incentives earned for completing wellness activities. Wellness dollars are either credited to personal wellness accounts or deposited in health savings accounts (HSA).