Benefits Glossary

 

AFTER-TAX BASIS

You pay for certain benefits with after-tax dollars that come out of your pay after all applicable taxes have been determined and withheld.

 

BENEFICIARY

The person or persons you designate to receive payment of your Life and Accidental Death and Dismemberment (AD&D) Insurance, 401(k) Savings Plan or HSA Plan. You can name anyone as your beneficiary, and you can change your choice at any time (unless you elect to assign your insurance—see the SPD for details). If you do not have a designated beneficiary at the time of your death, or if your beneficiary dies before you, your insurance will usually be paid in a lump sum to the survivors listed below in the following order of priority (see the SPD for details):

  • Spouse
  • Child(ren)
  • Parents
  • Siblings
  • Your estate

 

COINSURANCE OR COST SHARING

This is the portion of covered health care costs for which you are financially responsible. For example, the plan may pay 80% of the cost of a service and you would pay the remaining 20%.

 

DEDUCTIBLE

The out-of-pocket amount you must pay each plan year before the plan pays for eligible benefits.

 

ELIGIBLE DEPENDENTS

You may enroll these eligible dependents:

  • Spouse/domestic partner
  • Child (including your spouse’s/domestic partner’s child)
  • Stepchild or legally adopted child up to age 26
  • Unmarried children of any age who are or become disabled and dependent on you

 

EMERGENCY

A serious medical condition or symptom resulting from injury or illness that arises suddenly and requires immediate care and treatment to avoid endangering life or health.

 

EVIDENCE OF INSURABILITY (EOI)

This is sometimes called “proof of good health” and is used to qualify for certain amounts of life insurance coverage. You will need to complete an EOI form if you choose to increase your life insurance coverage amount outside of Open Enrollment.

 

FORMULARY

A formulary is a list of medications covered by your prescription plan. If you use a medication that is not on your plan’s formulary, you may be required to pay the full cost. To view the formulary for your plan, visit the plan’s website.

 

GENERIC

A generic drug is one that is no longer produced only under a brand name. Once a drug’s patent expires, many companies can begin to manufacture “generic” versions of a previously brand-name-only drug. Generic drugs are identical to brand-name drugs in chemical makeup (“active ingredients”), usage, strength and dosage. They are regulated and approved by the FDA just like brand-name drugs. The price you pay for generic drugs is less than you would pay for brand-name or formulary drugs.

 

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

The HIPAA privacy notice begins on page 7 of the New Hire Guide under Important Legal Information Annual Notices.

 

IN-NETWORK PROVIDER

A provider who has contracted with a health care plan (a medical, dental or vision plan) and has agreed to certain rates. In most cases, you pay less and receive a higher benefit when you use in-network providers. Check with your plan for coverage details.

 

NEGOTIATED RATES

The costs for health care services negotiated between the insurance carrier and in-network health care providers. Negotiated rates are usually less than usual, customary and reasonable (UCR) charges.

 

OUT-OF-NETWORK PROVIDER

A provider who has not contracted with a health care plan (medical, dental or vision plan) and has not agreed to certain rates. In most cases, you pay more and receive a lower level of benefits when you use out-of-network providers. See your plan for coverage details.

 

OUT-OF-POCKET MAXIMUM

The maximum amount you could pay in any plan year. Eligible expenses above this amount are typically paid by the plan.

 

PLAN YEAR

Our plan year is January 1 through December 31. You cannot change coverage in any of the benefit plans during this period unless you experience a qualified life event.

 

PREFERRED BRAND NAME

A preferred brand-name drug may have a lower cost than a non-preferred drug because it has been identified by the plan as more cost-effective. You can find out how different drugs are classified by your plan by visiting the plan’s website.

 

PRE-TAX BASIS

You pay for these benefits with pre-tax dollars that come out of your pay before federal income and Social Security taxes are withheld—and, in most states, before state and local taxes are withheld. This gives your contributions a special tax advantage and lowers your taxable income thereby lowering the actual cost to you.

 

FAMILY STATUS CHANGE/QUALIFIED LIFE EVENT

Family Status Change/Qualified life events include:

  • Change in legal marital status, such as marriage, divorce, dissolution of a domestic partnership, or death of a spouse or domestic partner.
  • Change in the number of dependent children due to birth, adoption, placement for adoption or death.
  • Change in court-ordered coverage for dependents.
  • Change in employment status, such as termination or commencement of employment by you or your spouse/domestic partner and dependents.
  • Change in dependent eligibility under your current coverage.
  • Change of residence or work site for you or your spouse/domestic partner and dependents that results in changes to your eligibility for a benefit.
  • Significant change in health coverage due to your spouse’s/domestic partner’s gain or loss of employment.

You may make changes to your coverage when you have a qualified life event; however, you must do so within 31 days of the event.

Due to the favorable tax treatment you receive by paying for your benefits coverage on a pre-tax basis, the Internal Revenue Service (IRS) requires strict compliance with the plan provisions that govern when changes are allowed. If you experience a qualified life event during the year:

  1. Contact the Tribune Publishing Benefits Service Center at 844-548-7662 within 31 days of the effective date of the status change. A benefits counselor will process your benefit election changes. You may also process the qualified life event yourself online through Empyrean.
  2. Submit documentation to the Tribune Publishing Benefits Service Center to support the qualified life event within 31 days of the effective date. Your elections will pend until documentation is received.
  3. Update your beneficiaries for life insurance through Empyrean and through Vanguard for retirement plans.
  4. Update your address, emergency contact information, and make adjustments to your tax withholdings through Workday.

IMPORTANT: If documentation is not received within the 31-day time frame, the status change will not be approved.  

 

SPECIALTY DRUGS

Specialty drugs require special handling, administration and/or monitoring. They are used to treat complex, chronic conditions (e.g., HIV/AIDS, transplant rejection, renal disease, etc.). You can find out how different drugs are classified by your plan by visiting the plan’s website.