Click one of the links below to go to that section.
This certificate is proof that you had coverage through a group or individual health plan. HIPAA requires group health plans, health insurance companies, and HMOs to furnish this document. It must be provided to individuals who lose coverage under an employer-provided health plan as well as individuals who elected COBRA but their coverage has ended.
The Consolidated Omnibus Budget Reconciliation Act of 1985 gives employees and their family members who lose their health benefits due to a qualifying event the right to choose to continue group health benefits provided by their employer’s plan. Learn more on our COBRA page.
An individual who has elected COBRA continuation of group health plan coverage and has made or is currently making timely premium payments to maintain eligibility for the coverage.
A notice furnished to a covered employee (and their spouse) at the time coverage under the plan begins. This notice informs employees of their COBRA rights and obligations under the law.
Short-term extension of group coverage after certain events which would otherwise cause coverage under the plan to end.
An individual policy that is sometimes offered to terminated employees or dependents who lose group coverage without providing evidence of insurability.
An eligible employee who has elected coverage under the group health plan.
All forms of comprehensive individual or group health insurance coverage, such as group, individual, Medicare, Medicaid, military, Indian Health Service, Peace Corps, Risk Pool, etc. It does not include disease-specific or limited coverage plans, such as cancer, dental, vision, or hospital indemnity.
CONEXIS service that provides billing to employees or retirees who are still eligible for plan benefits but no longer have health premiums deducted from their paychecks. Services usually result from a leave of absence, absence protected by the Family Medical Leave Act (FMLA), severance, or retirement.
Inability to perform all or some portion of the duties of one’s job due to a medically determined physical or mental impairment. A disability extension of COBRA benefits is limited to only Social Security disabled participants and their family members who are qualified beneficiaries. For more information, go to the Department of Labor website.
A notice sent to qualified beneficiaries after a qualifying event has occurred. This notice informs individuals of their rights to continue health plan coverage under COBRA. The employer and plan administrator have 44 days to provide this notice to qualified beneficiaries.
A period during which the qualified beneficiary can elect COBRA coverage. This period usually ends 60 days after the date that group coverage ends, or if later, the date of the election notice.
The Family and Medical Leave Act of 1993 (FMLA) is a law stating that employers must generally grant a covered eligible employee up to a total of 12 work weeks of unpaid leave during any 12-month period for one or more of the following reasons:
The law requires an employer to maintain coverage under any group health plan for an employee on FMLA leave. The same coverage must be provided as the employee’s coverage if they had continued working. This coverage is not COBRA coverage.
A 30-day period following the due date (typically the first day of each month) given to a qualified beneficiary in order to make a COBRA premium payment. Failure to make a payment in full before the end of the grace period may cause COBRA coverage to end. The grace period does not apply to your initial COBRA payment.
Any arrangement that an employer creates or maintains to provide employees and their families with medical care. This care may be provided through insurance, by a health maintenance organization (HMO), out of the employer’s assets on a pay-as-you-go basis, or otherwise.
Note: Life insurance is not considered “medical care” nor are disability benefits. COBRA does not cover plans that provide only life insurance or disability benefits.
A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn’t limit how much you can be charged if you enroll. Contact your state’s Department of Insurance to learn more.
The Health Insurance Portability and Accountability Act of 1996 and its amendments. This federal law enacted portability, accessibility, and accountability requirements for group health plans and health insurance issuers. The requirements contain provisions designed to:
Under HIPAA, if an employee acquires a new dependent by marriage, birth, or adoption, or if an employee declines coverage for themselves or an eligible dependent while enrolled in other coverage (including COBRA coverage) and then later loses that coverage for certain qualifying reasons, they may be able to enroll themselves in another group health plan without having to wait until the next open enrollment period. For example, an employee and her newborn child may be eligible for special enrollment rights under her employer’s group health plan upon the birth of the child.
Health insurance that is sold as an individual or family policy and is independent of a group health plan. Learn more on our COBRA Alternatives page.
Qualified beneficiaries who elect COBRA coverage are allowed 45 days after the date of their COBRA election (the date the completed COBRA Election Form is postmarked) to send in the first COBRA premium payment. This payment should satisfy the cost of coverage from the time that coverage would have been lost through the end of the month preceding the month that the 45-day initial premium payment deadline falls. For example, a June 1 election, based on an April 30 qualifying event and loss of group health coverage, would require an initial premium payment for May and June. It is due on or before July 15 (the 45th day after the COBRA coverage election).
This notice explains special enrollment rights under HIPAA to employees and their dependents. It also details if their group health coverage has a preexisting condition exclusion, these individuals may be eligible to receive pre-existing condition credit if they previously had health insurance benefits. The notice also explains that they are currently able to enroll in the insurance program. However, if they do not enroll during their initial enrollment opportunity, they may be limiting their eligibility for the coverage.
If a qualified beneficiary’s spouse or dependent child has a second 36-month qualifying event during the first 18 months of COBRA coverage (because of the covered employee’s termination or reduction of hours), this qualified beneficiary may receive up to 18 additional months of COBRA coverage (for a total of 36 months). This may be available to the covered spouse or dependent child due to:
Rules on how to give notice of a second qualifying event and the notification time period are in the employer’s Summary Plan Description (SPD).
A period during which an employer allows employees to enroll and make changes to their benefits, including health plan coverage. COBRA beneficiaries are allowed the same rights as active employees and may participate in the open enrollment process. See our Open Enrollment page for more information.
A medical condition that existed before the date that a new insurance policy starts.
The amount of money that qualified individuals pay for their COBRA coverage. Failure to make timely payments can result in losing coverage. More information is on our Paying for COBRA page.
Proving medically that you are qualified to purchase insurance (i.e., that you are a reasonable risk for the insurer).
An individual who was covered by a group health plan on the day before the qualifying event occurred that caused them to lose coverage. Only certain individuals can be qualified beneficiaries, and the type of qualifying event determines which qualified beneficiary is eligible for COBRA coverage. In addition, a child born to, or placed for adoption with, the covered employee while covered by COBRA is a qualified beneficiary. See our COBRA Qualified Beneficiaries page for more details.
Certain events that cause an individual to lose their group health coverage. The type of qualifying event determines which qualified beneficiary is eligible for COBRA coverage because of the event and the period of time that the plan must offer continuation coverage. See our Qualifying Events page for more details.
Before a group health plan must offer continuation coverage, a qualifying event must occur, and the group health plan must be notified of the qualifying event. The responsibility for providing the qualifying event notification depends on the type of qualifying event. The employer is responsible for notifying the plan of:
The employee or one of the qualified beneficiaries must notify the plan of:
Procedures and time limits are included in the employer’s Summary Plan Description (SPD).
Each qualified beneficiary may independently elect continuation coverage. For example, a covered employee may decide not to elect COBRA but choose to elect coverage for a dependent child.
A written document that gives important information about the plan. It includes what benefits are available under the plan, participants’ rights, beneficiaries under the plan, and how the plan works. COBRA rights provided under the plan are described in the SPD.
A dependent up to age 26 who qualifies for coverage under a parent’s group health plan.
Certain types of deductions that are subtracted from your income before the adjusted gross income is calculated for your taxes. These deductions are generally subtracted from your taxable income at the time you calculate your taxes, which helps reduce your overall tax burden.
An arrangement in which payments are transferred electronically rather than sending a paper check. Also called “electronic funds transfer” (EFT) or referred to as “direct deposit.”
The dollar amount available for use in an FSA, HRA, or HSA.
Individual(s) selected by the HSA account holder to inherit any HSA funds that remain in the account after the death of the account holder.
Used to designate a primary and secondary beneficiary for an HSA. Unless form is completed, an account holder’s estate is the default beneficiary. You can find this form in your online account.
An employee benefits plan that allows employees to choose from a “menu” of benefits options, similar to ordering food in a cafeteria. When offered through a cafeteria plan, benefit options may include medical, dental, and vision plans, group term life insurance, and flexible spending accounts. Cafeteria plans must meet specific IRS Section 125 regulations. Benefits are paid for on a pre-tax basis, which means employee contributions are deducted from their paychecks before taxes are calculated and withheld.
A special enrollment event that allows a plan participant to change their election mid-year instead of waiting until the employer’s open enrollment period. The employer’s plan must allow the change, and the change must be consistent with the type of event (such as a birth of a child increasing an election amount). See your employer’s Summary Plan Description (SPD) for specific plan details.
Allows an HSA account holder to change the designated beneficiary at any time. The change must be made in writing using this form. You can find this form in your online account.
A cost-sharing method in a health insurance policy that requires a policy holder to pay a percentage of all remaining eligible health care expenses after the deductible amount has been paid.
Sometimes called a co-pay, this is the fee an individual pays for health care services received. Based on an individual’s health plan, co-payments are the same dollar amount regardless of the total cost of the service.
The distance traveled between work and the employee’s residence.
A financial term that refers to the calculation or payment of interest on both the account balance and its accrued interest.
The combination of a pre-tax payment account (HRA or HSA) with a high deductible health plan. The pre-tax account allows employees to pay for services using pre-tax dollars. Depending on the type of account, it may be funded by the employer or the employee. The account funds can be used to satisfy the insurance plan deductible. There is a gap in coverage, known as a deductible gap, between the amount of money in the individual’s pre-tax account and the deductible. The insured employee must pay for the amount that is not covered by the pre-tax account. If health care expenses exceed the deductible amount, then the high deductible health insurance plan kicks in.
The dollar amount deducted from an employee’s paycheck on a pre-tax basis and redirected into a pre-tax account (FSA or HSA).
A bank or financial institution that holds and safeguards the HSA assets on behalf of the HSA account holder. CONEXIS partners with UMB Bank, n.a., for the custodian of our HSAs.
The amount of money an individual must pay out of pocket each year before the health plan begins paying for health care services, in full or in part.
The financial gap between the end of the pre-tax funded account (HRA or HSA) and the beginning of full health insurance coverage offered by a high deductible health plan. During the gap, the employee has sole responsibility for health care expenses.
A specific amount of health care dollars that the employer contributes to an FSA, HRA, or HSA for an individual employee.
The expenses related to dependent care that enable an individual or married couple to work, look for work or attend school. These expenses may include baby sitting, nursery school, preschool, before and after-school day care. Expenses may also include care for a spouse or dependent who is physically or mentally incapable of self-care and lives in your home for more than half the year. Find a complete list on our Eligible Expenses page.
A dependent care flexible spending account (FSA) is an employer-sponsored plan that allows you to set aside a portion of your income on a pre-tax basis and then use that money to pay for eligible, employment-related dependent care expenses incurred for a qualifying individual. (This program is also known as a dependent care assistance program or DCAP.) Learn more on our Dependent Care FSA page.
The person or entity (baby sitter, nanny, day care, etc.) providing dependent care services for an employee’s dependent.
Generally, the spouse and/or qualifying children of a covered individual. If you have an FSA or HRA, see your Summary Plan Description (SPD) for details. For HSAs, the spouse and/or qualifying tax dependent(s) of an HSA account holder.
The withdrawal of HSA funds; also refered to as a disbursement.
Using funds from more than one pre-tax account (FSA, HRA, or HSA) for reimbursement of the same expense. IRS rules do not allow this.
An expense that is used for medical purposes as well as general health, personal, or cosmetic use. For example, exercise equipment may be used for weight loss (medical purpose) or for general well-being (personal health purpose). For a dual-eligible expense to be an eligible expense, a CONEXIS Medical Determination Form must be completed by your doctor.
The date health plan coverage becomes active for an individual or family.
The amount you contribute to your FSA. You decide your election amount during your employer’s open enrollment period.
Generally, any individual with qualifying high deductible health plan (HDHP) coverage. Individuals entitled to Medicare or those who are claimed as tax dependents are considered “ineligible” and cannot contribute to HSAs. For more information, visit our HSA page.
The amount an employer contributes to an HSA or pays for an insurance premium.
HSA contributions that exceed the sum of the annual maximum contribution limit, and the catch-up contribution if applicable. Maximum annual limits vary depending on whether you have individual or family coverage. Find the limits for the current tax year on our HSA Contributions page.
A medical benefits statement sent to covered individuals by a health plan. It explains the services received, amount billed, amount paid to the health care provider, and the amount the policy holder must pay.
The federal corporation that insures bank deposits.
A cafeteria plan benefit established by Section 125 of the Internal Revenue Code. It’s funded by pre-tax employee contributions and reimburses employees for expenses incurred for certain qualified expenses, such as health care expenses and dependent care expenses. The benefits are subject to an annual “use-it-or-lose-it” rule. Visit our FSA home page for more details.
A period of time that immediately follows the end of the plan year during which you may use funds that remain in your account to pay for eligible expenses. The grace period begins on the first day immediately following the last day of the plan year, and in most cases, ends two months and 15 days later. Not all plans include this feature. Check your employer’s Summary Plan Description (SPD). Learn more on our Additional FSA Features page.
A health flexible spending account (FSA) is an employer-sponsored plan that allows you to set aside a portion of your income on a pre-tax basis and then use that money to pay for qualified out-of-pocket medical expenses. Find further details on our Health FSA page.
This feature only applies to health flexible spending accounts. If an employer’s plan includes a this feature, IRS rules allow health FSA participants to carryover up to $500 of unused health FSA funds to the following plan year. Employers may set a lesser maximum carryover amount, so it is important to read the Summary Plan Description (SPD) for carryover details. Learn more on our Additional FSA Features page.
A Health Reimbursement Arrangement (HRA) is a reimbursement account set up and funded by your employer that may be used to reimburse qualified out-of-pocket medical expenses for you, your spouse, or qualified dependent (eligibility depends on your employer’s plan and is specified in the Summary Plan Description). Check out our HRA home page for more details.
Tax-favored custodial account for an individual who is covered under a high deductible health plan that can be used to pay for their eligible health care expenses as well as those for their spouse and/or their tax dependents. Contributions may be made by the employee and the employer and are limited to a maximum amount each year. These contributions are rolled over from year to year and can be invested over time to pay for qualified medical expenses, or funds can be saved for retirement. Plus, the account is portable, which means it stays with the individual as they change jobs and funds are not forfeited. Learn more on our HSA page.
The maximum dollar amount that an HSA account holder can contribute to their HSA each year. The IRS sets the maximum amounts. Check out our HSA Contributions page for more details about limits for the current tax year.
Additional contributions above the HSA annual maximum limit for individuals who are age 55 or older by the end of the taxable year. See the rate for the current tax year on our HSA Contributions page.
A base HSA account in which contributions are deposited and funds accumulate over time and may be used toward eligible health care expenses. This is an interest-bearing account that is FDIC insured (up to the maximum amount permitted by law). For more information, see our HSA Investments and Savings page.
A bank account that, at the close of each business day, automatically transfers amounts that exceed (or fall short of) a certain level into or from a higher-interest earning money market account.* An HSA account holder must have a peg balance in order to use this investment option. Learn more on our HSA Investments and Savings page.
HSA account holders may choose to invest HSA funds when a peg balance is available as well as a minimum investment amount.* This account may be opened when balance eligibility requirements have been met. See our HSA Investments and Savings page for more details.
A health insurance plan that has a high minimum deductible, which does not cover the initial costs or all of the costs of medical expenses. The deductible forces the covered individuals to pay the first portion of a medical expense before the insurance coverage kicks in. The minimum deductible for an HDHP plan varies each year.
Under Internal Revenue Code Section 125, some employers provide an opportunity for employees to pay for individually-owned, qualified insurance coverage on a pre-tax basis through an IPR account. This option allows an employee to elect a pre-tax salary reduction amount equal to the employee’s annual premium during the plan year. Their annual IPR election amount is divided by the number of pay periods in the plan year and deducted on a pre-tax basis each pay period. The employee then files a claim and is reimbursed for qualified premiums.
Set of administrative laws structured together for use related to a specific topic. The Code is defined and published by the Internal Revenue Service (IRS).
A point-of-sale system that compares the items you are purchasing with a benefit card against a list of eligible items maintained by the merchant.
Tax form mailed to the HSA account holder that reports HSA distributions for the tax year.
Tax form mailed to the HSA account holder that reports HSA contributions for the tax year.
Tax form used to report the HSA account holder’s distributions (using IRS Form 1099-SA) and contributions (using IRS Form 5498-SA) for the tax year. The HSA account holder is responsible for completing this form and including it with their tax return.
A limited-purpose health flexible spending account (referred to as a limited-purpose FSA) is much like a typical, general-purpose health FSA; however, under a limited-purpose FSA, eligible expenses are limited to qualifying dental and vision expenses. Limited-purpose FSAs are usually paired with HSAs.
A CONEXIS form required for a dual-purpose expense that has both a medical purpose and a general health, personal, or cosmetic purpose. For the dual-purpose expense to be reimbursed as an eligible expense, this form must be completed by a doctor and submitted along with your supporting documentation. You can find a Medical Determination Form in your online account.
An electronic identifier that categorizes the type of merchant where you use your card. During the purchase process, the category information determines if your card can be used at that location. Doctors, dentists, vision care offices, hospitals, and other medical care providers use this identification process.
The market value of a mutual fund share. This is the price at which shares of a mutual fund are bought or sold. Net asset value is determined by subtracting the fund’s liabilities from the fund’s assets and dividing the result by the total number of shares outstanding.
In the case of a dependent care eligible expense, volunteer work and volunteer work for a nominal salary are not eligible expenses. Nominal salary refers to a small amount paid to the volunteer for their service.
The date that an individual’s HSA was established at the custodian (UMB Bank).
The period of time employees are given to decide whether they will participate in the cafeteria plan. Employees must select benefits, choose their annual election amounts if enrolling in an FSA or HSA, and complete the enrollment process before the enrollment period ends.
This is a benefit card purchase that requires additional attention from you. For more details, see unresolved card transaction requiring action.
Whether provided through insurance or otherwise, includes coverage for accidents, disability, dental care, vision care, and/or long-term care. HSA account holders may have this coverage along with an HSA.
The date a HSA transaction is posted to an account holder’s HSA.
Payment for insurance either in lump sum or by installments.
The portion of income you elect to set aside into an FSA before federal, state and Social Security taxes are calculated and deducted from your paycheck.
A cafeteria plan benefit that allows an employee to pay for qualified health care premiums with pre-tax dollars.
If HSA funds are unknowingly used for an ineligible expense, the HSA account holder can “redeposit” those funds into the HSA when funds have been determined as misused. The redeposit does not count against the HSA annual maximum limit.
A CONEXIS claim form used to document purchases of and request reimbursement for eligible out-of-pocket FSA and HRA expenses. You can find this form in your online account.
A CONEXIS benefit card purchase for which you have provided documentation, has been approved as an eligible expense, and no longer requires your attention.
A CONEXIS form used to document an outstanding card transaction and is submitted along with supporting documentation. It is sent along with your monthly activity statement if you have an unresolved card transaction. An interactive Return Form is available in your online account.
Remaining account funds that carry over to the following plan year. This feature does not apply to FSA plans. It is part of an HSA. The feature may be included in an HRA but the employer decides whether to include it. Check your HRA plan Summary Plan Description (SPD) for details.
Pre-determined period after the plan year ends. During this time, you may file claims for expenses incurred during the plan year. When the run-out time frame is over, you forfeit any unused funds. Not all plans include this feature. Check your employer’s Summary Plan Description (SPD).
Commonly referred to as a cafeteria plan. This plan must meet specific requirements of Internal Revenue Code Section 125, which allows employees to receive specific benefits on a pre-tax basis. The plan must provide a written document, a Summary Plan Description (SPD), which describes all benefits and establishes rules for eligibility and elections.
Commonly referred to as a commuter benefits plan. This plan allows employees to set aside funds on a pre-tax basis to pay for work-related transportation and parking expenses. There are monthly maximum amounts for both transportation and parking contributions; maximum limits are released by the IRS each year. For more information, visit our Commuter Benefits page.
This feature allows you to submit eligible expenses incurred after your termination. It is applicable to HRA and dependent care FSA plans. Not all plans offer this feature. Refer to your employer’s Summary Plan Description (SPD).
A required legal document that provides detailed information about a Section 125 cafeteria plan including criteria for participation, plan benefits, election rules, and general provisions. Employers must provide this document to employees who participate in the plan.
Proof of purchase of an eligible expense or payment for health care service. Examples include itemized merchant receipts, detailed pharmacy receipts, EOBs, and a provider’s statement of work.
A purchase made with your benefit card.
A pass, token, fare card, voucher, or similar item entitling a person transportation on mass transit facilities.
A benefit card purchase that requires additional attention from you. Many times supporting documentation is required. If you have a CONEXIS Elite Benefit Card, your monthly activity statement will list transactions requiring further action, and you will receive directions on how to resolve these transactions by completing a Return Form and submitting proper documentation.
The funds that remain in an account at the end of the plan year. Unused FSA funds are forfeited. Unused HRA funds may be rolled over to the following plan year if the employer’s plan allows the option. Check your HRA Summary Plan Description (SPD) for details.
A term created by the IRS to inform FSA participants to use their account funds before the plan year ends. Unused FSA funds are forfeited at the end of the plan year.
Transportation between work and the employee’s residence, but only if it is done in a “commuter highway vehicle.” The vehicle must have a seating capacity of six or more, and at least 80 percent of the mileage on the vehicle must be used for vanpooling purposes.
*Investments you make through your HSA are not FDIC-insured. Securities offered through UMB Financial Services, Inc., member FINRA, SIPC. UMB Financial Services, Inc. is a subsidiary of UMB Bank, n.a. UMB Bank, n.a. is a wholly owned subsidiary of UMB Financial Corporation. UMB Financial Services, Inc. is not a bank and is separate from UMB Bank, n.a. and other banks. Investments in securities, whether through the Money Market Sweep Account or through investments in the Self-directed Brokerage Account are:
Not FDIC-Insured • May Lose Value • No Bank Guarantee