ISCEBS Fellow key terms

A funding arrangement in which the employer pays claims up to a stated monthly limit and the insurer covers amounts above that limit, while the insurer also administers the plan for a fee.

A contract under which an insurer or third-party administrator processes claims and performs other plan functions for a fee, while the employer retains financial responsibility for paying all covered claims.

Coverage purchased by a self-funded plan sponsor that reimburses claims exceeding a specified threshold, either per person (specific) or for the plan as a whole (aggregate).

The per-participant claims level at which a specific stop-loss policy begins to reimburse the plan, often set as a dollar amount or a percentage of expected claims.

The total annual claims threshold for the entire covered group above which aggregate stop-loss insurance responds, typically set as a percentage of projected plan claims.

Rules that determine the order in which two or more health plans pay when a person is covered by both, so combined payments do not exceed the cost of care.

The health plan that pays its benefits first under coordination-of-benefits rules, with secondary plans considering its payment when determining their own liability.

A coordination-of-benefits method under which the secondary plan pays only the difference between the primary plan's payment and what the secondary plan would have paid as primary.

A fee benchmark reflecting the prevailing charge for a service in a geographic area, used by many plans to limit reimbursement to amounts deemed acceptable rather than billed charges.

The practice of a provider charging a patient the difference between the billed charge and the amount the health plan pays or recognizes as payable.

The maximum dollar figure a health plan recognizes as payable for a covered service under its provider contract or reimbursement methodology, before applying cost sharing.

A deductible structure in family coverage under which each member has an individual deductible, and the family deductible is satisfied when the combined member spending reaches a set amount.

A family deductible that must be satisfied by combined spending of all covered family members before any member receives benefits, with no individual-level carve-out.

The limit on covered in-network cost sharing a participant pays in a plan year, after which the plan generally pays 100 percent of covered expenses.

The share of covered expenses, expressed as a percentage, that the participant pays after the deductible is met, with the plan paying the remainder.

An employer-funded account that reimburses employees for qualified medical expenses, is notional rather than a funded trust, and may allow balances to carry over at the employer's discretion.

A tax-advantaged trust owned by an individual that can be funded by the individual or employer and used for qualified medical expenses when paired with a qualifying high-deductible health plan.

A health plan meeting statutory minimum deductible and maximum out-of-pocket limits, required as the companion coverage for making or receiving health savings account contributions.

An employer-sponsored account funded with pre-tax employee salary reductions that reimburses qualified expenses, generally subject to use-it-or-lose-it rules with limited carryover or grace-period relief.

A retirement arrangement in which the benefit is a formula-based amount, typically tied to pay and service, and the employer bears investment and longevity risk.

A defined benefit plan that expresses each participant's benefit as a hypothetical account credited with pay-based credits and interest credits, while assets are pooled and professionally invested.

The ratio of a defined benefit plan's assets to its funding target, used to measure funded status and to determine benefit restrictions and minimum contribution requirements.

The smallest annual employer contribution that satisfies statutory funding rules for a defined benefit plan, reflecting target normal cost and any shortfall amortization.

A qualified plan in which key employees hold more than a statutory share of account balances or accrued benefits, triggering minimum contributions or benefit accruals for non-key employees.

For top-heavy testing, an employee who during the determination year is an officer above a compensation threshold, a more-than-five-percent owner, or a more-than-one-percent owner earning specified compensation.

A nondiscrimination test comparing average elective deferral percentages of highly compensated employees with those of non-highly compensated employees to limit permitted deferrals.

A nondiscrimination test applied to employer matching and after-tax employee contributions, comparing average contribution percentages of highly compensated and non-highly compensated employees.

An employee who meets statutory tests, generally a more-than-five-percent owner or someone whose prior-year compensation exceeded a threshold indexed annually.

The timetable under which a participant earns a nonforfeitable right to employer-provided retirement benefits, subject to statutory maximums for qualified plans.

Payment of a participant's entire accrued benefit or account balance in a single amount, often eligible for favorable tax treatment if rolled over or paid under qualifying rules.

The minimum amount that must be withdrawn annually from tax-advantaged retirement accounts after a statutory age, with failure penalties for shortfalls.

The legal obligation of a plan fiduciary to act solely in the interest of participants and beneficiaries, with the care, skill, prudence, and diligence of a knowledgeable person.

A transaction between a plan and a party in interest or disqualified person that is barred by law unless an exemption applies, such as certain sales, loans, or service arrangements.

A person or entity with a specified relationship to an employee benefit plan, such as a fiduciary, service provider, employer, or union, subject to prohibited-transaction restrictions.

A statutory safe harbor shielding plan fiduciaries from liability for participant-directed investment losses when participants exercise control over their accounts and required disclosures are provided.

A written document setting forth a plan's investment objectives, risk tolerance, selection criteria, and monitoring procedures, serving as a governance framework for fiduciaries.

The federal contributory social insurance program providing retirement, survivor, and disability benefits to Canadian workers and their families, with benefits based on contributory earnings.

A federally funded pension paid to Canadians meeting age and residence requirements, subject to recovery through the tax system for higher-income recipients.

An income-tested federal benefit paid to low-income Old Age Security recipients, adjusted annually and reduced as other income rises.

A tax-deferred individual savings vehicle with contribution limits based on earned income, in which investment growth accumulates tax-free until withdrawal.

A Canadian account in which contributions are made with after-tax dollars and investment income and withdrawals are not taxed, with annual contribution room.

A tax-deferred payout vehicle into which RRSP assets may be transferred, requiring annual minimum withdrawals that increase with the annuitant's age.