Glossary

ACH

ACH stands for Automated Clearing House. An ACH transfer is an electronic money transfer between banks.

ACH credit transaction

ACH credit transactions let you “push” money online to accounts at different banks, either accounts you own or friends’ and family members’ accounts.

ACH debit transaction

ACH debit transactions involve money getting “pulled” from an account. When you set up a recurring bill payment, for example, the company you’re paying can pull what it’s owed from your account each month.

Active full-time employee

This is a person who works a normal workweek for an employer. Employees must work at least the number of hours shown in a plan's Schedule of Insurance.

Association

The party that originally brought the account/organization to Paylogix.

The association may be one of the following:

·        Agent / Agency

·        Broker

·        Consultant

·        Enrollment company

Benefit period

A period of consecutive days during which benefits for covered services are available to the plan member.

Broker

Insurance brokers are also called agents. They are licensed by states as agents, brokers or insurance producers. Insurance brokers help a person or business buy an insurance plan. Brokers represent the person or business buying insurance. However, they are usually paid by a commission from the insurer.

Case Number

A unique identifier used by the provider to identify an organization.

Because the case number is determined by the provider,one organization will have multiple case numbers associated with it. Dependingon the provider the identification number may be called one of the following:

·        Group Number

·        Client Number

·        Billing Number

·        Group Identifier

·        Client Identifier

·        Billing Control Number

Contract

This is a legal agreement. It is between a customer (an individual or group) and an insurance plan. It lists all details of the plan’s coverage. It also known as a benefit certificate or policy.

Contract holder

This is a legal term. It is a customer (an individual or group) who buys an insurance plan from an insurer.

Dashboard Portlets

The dashboard provides asingle screen snapshot view of key data. This information is arranged inportlets.  There are multiple portlets onthe standard dashboard.  

Dependent

This is a person who is covered by another person’s plan. It can be a child, spouse or domestic partner.

Effective date

This is the date a benefit plan becomes active. The coverage starts on this day.

Eligibility

This includes terms that decide who can get coverage. The requirements vary. They could include health conditions, how long a person is employed, job status and more.

Enrollee

Also known as a member. A member is someone who belongs to a benefit plan. Sometimes a member is known as an enrollee.

Enrollment period

This is when people can sign up for a plan.

Group coverage

This is a plan offered by a plan sponsor to an employee group or other group. The plans offer health, dental, life insurance coverage and more. Group plans may also be offered to retirees.

Group insurance

Also known as group coverage. This is a plan offered by a plan sponsor to an employee group or other group. The plans offer health, dental, life insurance coverage and more. Group plans may also be offered to retirees.

Late entrant (also known as late enrollee)

There are certain times of the year when workers can choose or change benefits. The main time is called open enrollment. New employees can enroll when they first start. And those who get married or have a baby can make changes in their coverage when this change in their life occurs.

Late entrants are: New employees who do not sign up within 31 days of being hired. They later choose coverage during open enrollment. Employees who do not choose or change coverage within 31 days of getting married or having a baby. They later do so during open enrollment.

Open enrollment

People make choices about their benefit plan coverage during this period. Their choices are for coverage in the next year.

Organization

The group that is serviced by Paylogix. From an organization, Paylogix will collect premium and data for individuals.

An organization is also known as:

·        Account

·        Case

·        Client

·        Employer

Participant

Depending on the type of organization, the individual participant may be called different names, including:

·        Associate

·        Employee

·        Enrollee

·        Member / Team Member

·        Policy Holder

·        Contract Holder

Pay Frequency

The organization’s payroll frequency, or how often they pay employees.

 ·        Weekly = 52 pay periods per year

·        Bi-Weekly = 26 pay periods per year

·        Semi-Monthly = 24 pay periods per year

·        Monthly = 12 pay periods per year

Policy holder

This is a person who has a contract with an insurance company.

Premium

This is the amount paid to an insurance company for coverage. A person can pay it directly. Sometimes a person has a plan with an employer. Then this cost might be shared between the person and the employer.

Provider

Traditionally, the provider was an insurance company. However, benefit plans now include many options that are not insurance. For that reason, the provider may be referred to by one of the following:

·        Carrier

·        Insurance Carrier

·        Insurance Company

·        Insurer

Not to be confused with "provider" in a health plan, with is used to mean a medical professional that is providing care to the insured.

Qualifying event

These are events that let members change their health benefits. Examples include death, job loss, divorce and marriage.

Wire Transfer

Wire transfers help move money electronically from one person to another, domestically or internationally, using banks or transfer providers.