Bronze Health Plan:
Health insurance plans are categorized by metal levels based on the price of the monthly premium and how much the health plan pays for covered services. A bronze health plan is the lowest level of the metal health plan categories with monthly premiums that are typically the lowest. But with that low premium comes low cost coverage by the insurance carrier. That means the insured person usually ends up paying more out of pocket for care received than they would if they had a higher level health plan. Bronze level deductibles can be very high and the plans might have a more limited list of covered services than under a higher level plan.
Exclusive Provider Organization (EPO) Plan:
A managed care plan where services are covered only if the insured goes to a doctor, specialist, or hospital in the plan’s network (except in an emergency).
Flexible Spending Accounts (FSA):
FSAs are employer-sponsored spending accounts into which employees can deposit tax-free dollars to spend on eligible health expenses. Employers can choose to contribute money to employees’ accounts but they don’t have to. All money contributed to an FSA must be used before the end of the plan year otherwise it will be forfeited. Your employer can choose to offer you either a 2.5 month grace period in which to use your remaining contributions or the ability to roll over up to $610 (as of 2023) of unused funds into the next plan year. Any money rolled over won’t affect your contribution limit for the following plan year. To learn more about FSAs, check out our FSA Guide.
Gold Health Plan:
Health insurance plans are categorized by metal levels based on the price of the monthly premium and how much the health plan pays for covered services. A Gold health plan is the second highest level of health insurance with monthly premiums that are typically higher than both Bronze and Silver plans and a lower deductible. Insured persons with a Gold level plan will likely pay lower out-of-pocket costs for covered services after the deductible is satisfied.
minutes is the average amount of time employees spend enrolling in benefits each year, compared to four hours to select a mobile phone, according to a report by Plan Sponsor.
Health Maintenance Organization (HMO):
A type of health insurance plan that usually limits coverage to care from doctors who work for, or contract with, the Health Maintenance Organization (HMO). The HMO generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
Health Savings Account (HSA):
An easy and smart way to pay for qualified medical expenses for the account holder and their dependents. It’s owned by the individual and is theirs for life. They can contribute to it tax-free while enrolled in a High Deductible Health Plan (HDHP) and continue to use their contributions tax-free once they’re covered by another form of health insurance. Once they turn 65, their HSA converts to a traditional retirement account with one exception: distributions for qualified medical expenses remain tax-free.
An HSA offers triple tax savings:
- Pre-tax or tax-deductible contributions
- Tax-free interest and investment earnings
- Tax-free distributions, when used for qualified medical expenses
In order to contribute to an HSA, you must have an HSA-eligible health plan.
High-Deductible Health Plan (HDHP):
A health insurance plan defined by lower insurance premiums and a higher deductible. With an HDHP, the insured individual must pay for all health care costs up to the deductible before insurance pays for services. However, preventative care is covered 100%. HDHPs are also the only health insurance option that can be paired with a Health Savings Account (HSA).
The IRS sets minimum deductibles and out-of-pocket maximums each year for HDHPs for both individual and family coverage.
An HSA can help pay for the high-deductible or be saved for future medical costs. But not all HDHPs can be paired with an HSA.
See also: HSA-eligible Health Plan
HSA-eligible Health Plan:
A High Deductible Health Plan (HDHP) that meets the IRS-issued minimum deductible and an out-of-pocket maximum requirements for the plan year. These amounts change annually based on the rate of inflation. HDHPs that fit within the IRS guidelines are eligible to be paired with a Health Savings Account (HSA).
Plan participants can use an HSA to save and pay for their deductible tax-free, as well as future medical costs. Read more about what makes an HDHP HSA-eligible.
See also: High Deductible Health Plan
Health Reimbursement Arrangements (HRAs):
HRAs are accounts into which an employer deposits money for employees to use to reimburse for eligible medical expenses. There are many types of HRAs, each with a different set of rules and functionality. But there are a few overlapping characteristics like:
- The employer decides how much they’d like to contribute to each account.
- The employer determines which medical expenses the money can be used to reimburse for.
- The employer gets to decide for whose expenses the HRA can be used and how employees qualify to participate (e.g. only full-time, W-2 employees).
- The employer gets to choose what happens to the unused HRA money at the end of the plan year.
of employers say they are considering adding a Lifestyle Spending Account to their benefits package according to a study by Mercer.
Lifestyle Spending Accounts (LSAs):
LSAs are accounts into which employers put money for employees to use on everyday expenses. Employers have a lot of flexibility in how they design their LSAs and can choose the following:
- How much they’ll contribute annually.
- Which expenses employees can use the money for.
- What happens to any unused allocations at the end of the plan year.
Expenses for which employers could allow reimbursement include:
- Gym memberships
- Home office equipment
- Home gym equipment
- Massages
- Wellness and meditation apps
Any money employees use from their LSA is taxed at the appropriate income tax rate.
Medical Travel Accounts (MTAs):
An MTA is intended to help employees and any necessary travel companions pay for travel that is medically necessary. It can’t be used to pay for the treatment itself, but it can be used to pay for things like gas, mileage, a rental car, plane tickets, parking, and hotel stays. There is no annual limit on MTA contributions and employers have a lot of control over how they design their plans. Things that employers get to determine include:
- The radius from the employee’s home that qualifies as “medical travel” (e.g. 50 miles).
- The expenses for which employees can contribute.
- Whose medically necessary travel is eligible for reimbursement.
- The reimbursement process (as long as it's HIPAA compliant).
- What happens to leftover funds at the end of the plan year.
MTAs are an after-tax benefit and as such, employees pay income tax on the amounts they use.
Platinum Health Plan:
Platinum health plans are typically considered the highest tier of the metal-rated health insurance plans. These plans typically charge the highest premiums, have low to no deductible and cover the widest range of services at the highest coverage levels. Participants of a platinum health plan would typically have low out-of-pocket costs after the premium has been paid.
Point of Service (POS) Plans:
A type of plan in which the insured pays less if they use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require a referral from a primary care doctor in order to see a specialist.
Preferred Provider Organization (PPO):
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. PPO plan patients pay less if they use providers that belong to the plan’s network. Doctors, hospitals, and providers outside of the network can be used for an additional cost.
Silver Health Plan:
This is the second highest tier of the metal-rated health plans. Silver plans typically have higher monthly premiums than bronze plans and lower premiums than gold level plans. Most HSA-eligible HDHPs are silver health plans. Silver health plans can have lower deductibles than both gold and platinum plans, but higher deductibles than bronze plans. They might result in higher out-of-pocket costs after the monthly premium, but if the silver plan is an HDHP, participants can use an HSA to save for those out-of-pocket costs tax-free.