Glossary of Benefits Terms

Health Benefits Terms

The sharing of certain covered expenses by the plan and the plan participant. For example, if the plan covers an expense at 80 percent (the plan’s coinsurance), your coinsurance is 20 percent of the provider’s charge.
Coinsurance Limit
The coinsurance limit is the maximum that you must pay out of pocket for your coinsurance share each calendar year.
Copayment (copay)
The specified dollar amount or percentage required to be paid directly to an in-network provider.
The amount of covered expenses that a member must pay each plan year before the plan begins to pay benefits.
A member’s spouse, civil union partner, same-sex domestic partner (as defined by P.L. 2003, c. 246), or child(ren) under the age of 26. Children include natural, adopted, foster, and stepchildren. If a covered child is not capable of self-support when he or she reaches age 26 due to a mental or physical disability, coverage may be continued subject to approval.
In-Network Provider or Participating Provider
Any physician, hospital, skilled nursing facility, or other individual or entity involved in the delivery of health care or ancillary services that contracts to provide covered services to plan participants for a negotiated charge.
Out-of-Network Provider
This term generally is used to mean providers who have not contracted with a health plan to provide services at negotiated fees; or, with an HMO, an in-network provider who is furnishing services or supplies without a referral from the patient’s PCP.
Out-of-Pocket Maximum
The out-of-pocket maximum is the maximum amount you must pay toward covered medical expenses in a calendar year. Once you reach this maximum, the plan pays 100 percent of your remaining covered expenses for the rest of the year.
Urgent Care
Services received for an unexpected illness or injury that is not life threatening but requires immediate outpatient medical care that cannot be postponed. An urgent medical condition requires prompt medical attention to avoid complications and unnecessary suffering or severe pain, such as a high fever.

* Health benefits term definitions provided by the New Jersey Division of Pensions and Benefits (NJDPB)

Leaves of Absence Terms

Family and Medical Leave Act (FMLA)
The Family and Medical Leave Act (FMLA), a federal law, provides 12 weeks of unpaid leave that protects you from negative impacts to your job when you take time off or a leave of absence for qualifying reasons.
New Jersey Family Leave Act (NJFLA)
The New Jersey Family Leave Act (NJFLA) provides 12 weeks of unpaid leave entitlement to eligible employees.
Temporary Disability Insurance (TDI)
Temporary Disability Insurance (TDI) is managed by the State of New Jersey, and provides cash benefits to eligible New Jersey workers who suffer an illness, injury, or other disability that prevents them from working.
Family Leave Insurance (FLI)
Family Leave Insurance (FLI) is managed by the State of New Jersey, and provides eligible New Jersey workers cash benefits for up to six weeks to bond with a newborn or newly adopted child, or to provide care for a seriously ill or injured family member.
Unpaid Leave
After exhausting all of your accrued time, you will no longer be paid by Montclair State University.