Benefits

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Glossary

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

A

Accidental Death & Dismemberment (AD&D)

AD&D is an Accidental Death and Dismemberment insurance plan that is in addition to any basic life insurance and/or supplemental life insurance coverage you may have. This insurance will pay in case of loss of life or dismemberment (loss of a limb or sight) due to an accident.

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C

COBRA

The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) is a federally mandated program that allows you to continue benefits coverage under Schwab's group medical, dental and vision plans if you terminate employment, or you and/or any eligible family members would otherwise lose eligibility for coverage because of certain qualifying events.

Schwab also provides COBRA-like benefits to domestic partners and their children who lose benefits because of qualifying events (for most health plans).

Co-Insurance

Co-Insurance is the amount you and the plan pay toward covered expenses, usually expressed as a percentage.

Plan Network Non-Network
Core PPO Plan You pay 15%; plan generally pays 85% You pay 40%; plan generally pays 60%
HSA PPO Plan You pay 15%; plan generally pays 85% You pay 40%: plan generally pays 60%
Out-of-Area Plan You pay 20%; plan generally pays 80%
Copay Plan There is no co-insurance in this plan.

Copayment

A copayment or copay is the amount you pay each time you receive certain covered services. The Copay is a flat dollar amount and is paid at the time of service or when billed by the provider. If the eligible expense is less than the copay, you are only responsible for paying the eligible expense and not the Copay.

Copay Plan

The Copay Plan provides coverage only when you receive medical care from providers or facilities in the UnitedHealthcare Choice network, except for emergency care. You pay no deductibles, and eligible expenses are covered at 100% after your copayments.

Coordination of Benefits

  • If you have other health coverage in addition to the Core PPO, HSA PPO, Out-of-Area, or Copay Plans and Delta Dental Plans, your Schwab benefits will coordinate with your other plans to pay their portion of covered charges.
  • The Schwab plans use the "non-duplication method" to coordinate benefits when you have coverage under more than one medical or dental plan (for example, you are covered by a Schwab plan, and your spouse or domestic partner is covered by another employer's plan and our plan). One plan is primary, the other secondary.
  • Schwab is usually primary (obligated to pay a claim first, as if no other plan exists) for the employee. If you cover dependents and the other plan is the primary payer for your dependents, and Schwab is the secondary payer, the total benefits paid from all plans will not exceed the amount payable under Schwab's plan. This means if the primary plan pays benefits equal to or greater than Schwab's plan, Schwab's plan will not make an additional payment.

    For example, let's say your covered dependent received medical services that cost $2,000, his/her primary plan paid $1,700, and the maximum benefit Schwab would pay was $1,600. Since the payout from the primary plan exceeded Schwab's maximum benefit, you would not receive payment from Schwab's plan, and you would be responsible for paying the remaining $300. Using this same example, if the primary plan only paid $1,500, then Schwab's plan would pay $100, and you would be responsible for paying the remaining $400.

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D

Deductible

The annual deductible is the dollar amount you must pay before a particular plan starts paying benefits.

  • Each enrolled dependent has an individual deductible; for medical, the family has a maximum combined deductible. (In the HSA PPO Plan the entire deductible must be met before benefits are paid)
  • Once a family has paid the maximum combined deductible for the year, individual family members will not have to fulfill their individual deductibles.
Certain expenses you pay do not count toward your annual deductible. For medical plans, for example, expenses that do not count toward the annual deductible include:

  • Co-payments for prescription drugs and network care (such as an office visit).
  • Penalties for failing to receive pre-certification for care, when required.
  • Charges that exceed reasonable and customary guidelines.
  • Expenses for services or supplies the plan doesn't cover.
  • Care that the plan provider does not authorize as medically necessary.

Annual Deductible for Medical Plans

Plan Network Non-Network
Core PPO Plan $300 per person; $900 per family $600 per person; $1,800 per family
HSA PPO Plan $1,250/year for single coverage; $2,500/year for family coverage (1 or more dependents) $2,500 a year for single coverage; $5,000/year for family coverage (1 or more dependents)
Out-of-Area Plan $250 per person; $650 per family
Copay Plan No deductible

Default Coverage

Default coverage provides basic coverage for the employee only, which includes:

  • Vision coverage
  • Two times (2x) base pay life and accidental death and dismemberment insurance
  • Short term disability coverage only where it is required by law (in California, New York, New Jersey, Rhode Island, Hawaii and Puerto Rico). This coverage is similar to the state level of benefits, with limited state maximum limits and does not include long-term disability coverage.

Default coverage does not include any medical coverage, dental coverage, disability coverage, supplemental or dependent life insurance, or participation in the Health Care and Dependent Care Flexible Spending Accounts.

Dental Maintenance Organization (DMO)

A dental plan that operates like an HMO. Out-of-pocket costs are generally low, but you are required to use dentists within the DMO's network to receive benefits. You pay either a percentage of the cost or a set copayment, depending on which DMO you choose.

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E

Explanation of Benefits (EOB)

After processing your health plan claim, the health plan provider will send you a statement outlining the amount that was paid by the plan and the amount, if any, that you are responsible for paying.

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F

Family Status Change

After your initial enrollment in Schwab health care benefits, you can only make changes:

  • as a result of a qualifying family status change--an event where the IRS allows employees to add or drop dependents or make changes to health care coverage, depending on the type of event, or
  • at Open Enrollment (once a year in the fall for an effective date of following January 1).

Qualifying family status changes include a change in:

  • marital status.
  • number of dependents (birth of a child, adoption, death of dependent).
  • an employee's, spouse's or domestic partner's employment status.
  • dependent eligibility (age requirements of plans, student status or similar circumstance).
  • residence.

You must submit a Family Status Change Form to Schwab within 31 days of the qualifying event change.

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H

Health Maintenance Organization (HMO) - Kaiser California & Colorado Plan

A type of medical plan in which out-of-pocket costs are generally lower, but you are required to use doctors and providers within the Kaiser CA and CO network to receive benefits. Most services are covered at 100% after you pay a co-payment.

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I

IRS Qualifying Child

Generally, an individual is a taxpayer's "IRS qualifying child" if:

  • the individual lives with the taxpayer for more than half the year; and
  • the individual is the taxpayer's child, brother, sister, stepbrother or stepsister (or a descendant of any of these relatives); and
  • the individual is under age 19 or, if a fulltime student, under age 24 or totally and permanently disabled; and
  • the individual doesn't provide more than 50% of his or her own support for the year.
  • For example, if your child lives with a relative such as a parent or a grandparent, then your child most likely is that relative's "IRS qualifying child." In that case, your child may not be your tax-qualified dependent even if you provide all or a portion of that child's support.

IRS Qualifying Dependent

Generally, a person is a taxpayer's "IRS qualifying relative" if the person:

  1. is not the taxpayer's or anyone else's "IRS qualifying child" (as defined above); and
  2. receives over 50% of his or her support for the year from the taxpayer; and
  3. is the taxpayer's relative (e.g., a parent, grandparent, child, grandchild, sibling or in-law) or a non-relative (e.g., a domestic partner) if the non-relative, for the entire year, lives with the taxpayer and is a member of the taxpayer's household.

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L

Lifetime Maximum Benefit

There is a lifetime maximum benefit payable per individual for Schwab's medical plans.

  • Under the Core PPO Plan and HSA PPO and Copay medical plans, there is no lifetime limit for in-network medical services.
  • For non-network services the Core PPO, HSA PPO and Out-of-Area plan's lifetime maximum benefit is $2 million per enrolled person.
  • There is no lifetime maximum benefit for Kaiser California or Colorado plans.

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M

Medically Necessary

Each medical, dental, and vision plan covers appropriate, medically necessary services and supplies. As the claims administrator, each plan reserves the right to determine whether any medical, dental, or vision expense is necessary.

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O

Open Enrollment

Your once-a-year chance to review the benefit plans Schwab offers and change your coverage for the coming year. The decisions you make during open enrollment will be effective from January 1 through December 31 of the following year.

Out-Of-Pocket Maximum

  • Most of Schwab's medical plans protect you by limiting the amount you pay (your out-of-pocket costs) each calendar year.
  • The percent of covered expenses you pay counts toward the out-of-pocket maximum.
  • Once your out-of-pocket costs reach a particular plan's annual maximum, the plan pays 100% of most remaining covered charges for the rest of the calendar year.
  • The following expenses do not count toward your out-of-pocket maximum for the Core PPO, Out-of-Area, and HSA PPO Plans:

    • Co-payments for office visits and prescription drugs.
    • The $500 penalty for not pre-certifying certain types of care under the Core PPO, Out-of-Area and HSA PPO Plans.
    • Charges that exceed reasonable and customary guidelines.
    • Expenses for services or supplies the plans do not cover.
Plan Network Non-Network
Core PPO Plan $2,000 per person; $5,000 per family $4,000 per person; $10,000 per family
HSA PPO Plan $2,900 per person; $5,800 per family $5,000 per person; $12,500 per family
Out-of-Area Plan $1,500 per person; $3,000 per family
Copay Plan No out-of-pocket limit

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P

Preferred Provider Organization (PPO)

  • A PPO plan is a type of medical plan where you decide each time you need services whether or not to stay in the network.
  • Benefits are usually greater when you use doctors and facilities in the network.
  • The plan does not require you to select a Primary Care Physician or receive authorization to visit a specialist.
  • The Core PPO Plan and HSA PPO Plan are PPO plans.

Pre-Existing Condition

For the medical plans, a mental or physical condition for which you received treatment, consultation care or services--including diagnostic measures--or took prescribed drugs or medicine before your medical plan coverage started. Schwab's medical plans do not have pre-existing condition exclusions.

For the short-term and long-term disability plans, a mental or physical condition for which you received treatment, consultation care or services--including diagnostic measures--or took prescribed drugs or medicine during the three consecutive months before your disability plan coverage started, or you increased your disability coverage.(Pregnancy is a pre-existing condition.)

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R

Reasonable and Customary

The amount Schwab's medical or dental plans pay to non-network and out-of-area doctors, dentists and facilities is based on reasonable and customary charges--what doctors, dentists, hospitals and providers in your geographic area charge for similar care. The plans do not cover any charges that exceed reasonable and customary guidelines. You are responsible for paying these costs.

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T

Tax-qualified Dependent

Eligible dependent for whom you can make pre-tax contributions for health plan coverage. A tax-qualified dependent is either your IRS Qualifying Child or your IRS Qualifying Relative.

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