Benefits Glossary

Accidental Death & Dismemberment (AD&D) - Administered by Fort Dearborn Life. This policy provides the member or designated survivor(s) with a monetary benefit in the event of accidental death or dismemberment, such as the loss of a limb or an eye.

Annual Enrollment - The once-a-year opportunity for employees to make insurance changes. It typically occurs during July, with the changes taking effect at the beginning of the new plan year on September 1.

Basic Coverage - This coverage only provides insurance for the employee. It contains the UT Select PPO medical plan, $10,000 term life insurance and $10,000 accidental death & dismemberment insurance. Full-time employees receive this coverage automatically and part-time employees must enroll within the first 31 calendar days of benefits eligible appointment. Adding dependent coverage or optional coverage must also be done within the first 31 calendar days of benefits eligible appointment.

Beneficiary - The person(s) designated by the employee to receive survivor benefits under the term life insurance and accidental death and dismemberment insurance plans. The form to name a beneficiary can be found on HRS Document Express under Insurance Forms.

COBRA - Employees may continue medical, dental or vision coverage due to termination of employment, or movement to a benefits ineligible position. Dependents may continue medical, dental or vision coverage due to death of the employee, divorce from a spouse employed by UT Austin, or a dependent child turning age 25. There is a 60-day enrollment period, beginning after insurance benefits terminate.

Co-insurance - A form of cost-sharing in which the member and the plan each pay a set percentage for covered services.

Co-payment - A fixed amount paid by the member for covered services at the time they are rendered or for prescription medications.

Dental Maintenance Organization (DMO) - The DMO plan is administered by Assurant Dental. The insured must choose a Primary Family Dentist (PFD) from a list of network dentists in order to receive benefits. A co-payment is due at the time covered services are rendered. The PFD form to complete is located on HRS Document Express under Insurance Forms.

Deductible - A flat dollar amount that a member pays for covered services before the plan begins to share the cost of those services.

Dependent - A legally married spouse or unmarried child under 25 years of age. The dependent information form can be found on HRS Document Express under Insurance Forms.

Emergency Care - Medical care necessary to treat a sudden illness or injury that is life or limb-threatening.

Evidence of Insurability (EOI) - A questionnaire about an applicant's past and current health history that is provided to the appropriate insurance company. The insurance company uses this information to approve or deny the requested coverage.

Flexible Spending Accounts (UT Flex) - Administered by PayFlex Systems. A means of sheltering certain medical care and day care expenses from taxes. Employees must enroll in the accounts each Annual Enrollment.

Long Term Care - Administered by CNA. An optional insurance policy that provides a daily monetary benefit amount for necessary services when individuals become incapable of caring for themselves.

Long Term Disability - Administered by The Hartford. An optional insurance policy that may provide 60% of an employee's annual salary if the employee is unable to work for more than 90 days due to illness or injury.

Out-of-Area - Benefit of the UT Select PPO plan that allows employees living outside of Texas or New Mexico to receive coverage for medical services. The benefit is based on the employee's US mail address. There is a $250 deductible before the plan pays 75% of all services considered reasonable and customary and the member pays 25%. The maximum amount payable by the member is $1,750 for reasonable and customary charges per plan year. The member is responsible for charges in excess of those considered reasonable and customary.

Out-of-Network - Benefit of the UT Select PPO plan that allows employees to receive benefits even when utilizing providers that are not part of the Blue Cross Blue Shield PPO network. There is a $500 deductible before the plan pays 60% of all charges considered reasonable and customary and the member pays 40%. The maximum amount payable by the member is $4,000 for reasonable and customary charges per plan year. The member is responsible for charges in excess of those considered reasonable and customary.

Plan Year - The period from September 1 through August 31. It is the same as the university's fiscal or academic year.

Pre-certification - Advance approval from the insurance company required to receive mental health benefits. Pre-certification is obtained by the member or provider contacting the insurance company.

Preferred Provider Organization (PPO) - The UT Select PPO plan is administered by Blue Cross Blue Shield of Texas. Members have the option to use network or non-network providers. To receive network benefits, members must utilize Blue Cross Blue Shield PPO providers. An office visit is a $25 co-payment with a family care physician and a $30 co-payment with a specialist. For other covered services, there is a $250 deductible before the plan pays 80% of all services considered reasonable and customary and the member pays 20%. The maximum amount payable by the member is $1,750 for reasonable and customary charges per plan year. Network providers may not bill members for any charges above those considered reasonable and customary.

Premium - The total monthly cost of insurance coverage.

Premium Redirection (UT Flex) - Eligible insurance premiums are deducted from an employee's paycheck on a pre-tax basis to help reduce taxable income. Enrollment is automatic.

Premium Sharing - The amount of money the State and the university provide an employee to help offset the cost of insurance. The exact amount allocated depends on employment status (part-time or full-time) and on the level of coverage (employee only, employee and spouse, employee and children, or employee and family).

Prescription Drug Service - Administered by Medco Health Solutions. Provides retail and mail order pharmacy benefits for a co-payment. A $50 deductible per member per plan year applies before any co-payments are made.

Generic Drugs - Medications that are not a brand name medication, but by law must have the same active ingredients as the brand name medication and are subject to the same standards of their brand name counterpart. Generic drugs usually cost less.
Preferred Drugs - Brand name medications preferred for their clinical effectiveness and opportunities to help contain the Plan's cost.
Non-Preferred Drugs - Medications that are not part of the preferred drug list.

Qualified Status Change - An event that allows employees to make certain changes to insurance coverage. Common examples are marriage, divorce, birth, death, or loss or gain of other insurance coverage. The employee must submit all necessary paperwork and supporting documentation within 31 calendar days of the date the event occurred in order to make changes.

Short Term Disability - Administered by The Hartford. An optional insurance policy that may provide 60% of an employee's weekly salary if the employee is unable to work for more than 30 days due to illness or injury.

Special Dependent - Adopted children, step-children, children under legal guardianship, grandchildren, and incapacitated children over 25 years of age. Additional paperwork is required to apply for coverage. Please contact the Human Resource Service Center for assistance with this type of enrollment.

Term Life Insurance - Administered by Fort Dearborn Life. This policy provides a designated survivor(s) with a monetary benefit.

Urgent Care - Medical care necessary to treat a sudden illness or injury that is not life or limb-threatening.

UT Touch - The electronic enrollment system used during the Annual Enrollment period to make insurance selections.

Vision Care - Administered by Superior Vision Services. The plan allows members to receive an eye exam and a benefit for eyeglasses or contact lenses.

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