It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

Glossary
This glossary has many commonly used terms, but it is not a full list. These glossary
terms and definitions are intended to be educational and may be different from
the terms and definitions in your plan. Some of these terms also might not have
exactly the same meaning when used in your policy or plan, and in any such case,
the policy or plan governs. (See the Uniform Benefits policy in the It’s Your Choice:
Reference Guide or for the other plans, see the Medicare Plus (ET-4113) and
Standard Plan (ET-2112) benefit booklets at etf.wi.gov/publications/insurance.htm.)
To view the federal Uniform Glossary, see: etf.wi.gov/members/health-plansummaries.htm.
If you need a hard copy mailed to you, contact ETF at
1-877-533-5020.
Allowed Amount: Maximum amount on
which payment is based for covered
health care services. This may be
called “eligible expense,” “payment
allowance” or “negotiated rate.” If your
provider charges more than the allowed
amount, you may have to pay the
difference. (See Balance Billing.)
Alternate Health Plans: The insurance
plans in the Wisconsin Public Employers
Program that offer Uniform Benefits.
Examples of this are Health Maintenance
Organizations (HMOs) and Preferred
Provider Organizations (PPOs).
Annuitant: A retiree, beneficiary, or
survivor of the retiree or beneficiary
receiving benefits under the Wisconsin
Retirement System.
Appeal: A request for your health
insurer or plan to review a decision or a
grievance again.
Balance Billing: When a provider bills you
for the difference between the provider’s
charge and the allowed amount. For
example, if the provider’s charge is $100
and the allowed amount is $70, the
provider may bill you for the remaining
$30. A preferred provider may not
balance bill you for covered services.
CAHPS ® (Consumer Assessment of
Healthcare Providers & Systems): A survey
used to measure satisfaction based on
consumer experiences.
COBRA (Consolidated Omnibus Budget
Reconciliation Act of 1986): An option
that allows an insured member to
continue their employer-sponsored group
health insurance coverage for a limited
time under certain circumstances after
losing eligibility for their health insurance.
The member is responsible for paying the
entire premium.
Decision Guide Page 88