Administrative Services

EMPLOYEE WELLNESS & BENEFITS


Contact Us:

Address:

1526 K Street, Suite 110
Lincoln, NE 68508

Email:

as.employeebenefits@nebraska.gov

402.471.4443 - Lincoln
877.721.2228

Glossary of Terms

Term: Definition:
CNC
Configurable Network Computing

Analysts who maintain the web servers and technical aspects of NIS.

COBRA
Consolidated Omnibus Budget Reconciliation Act of 1985

Allows for continuation of health/dental/vision/EAP/flex for any employee or dependent who would otherwise lose group coverage due to a qualifying event. Provides continuation for 18 months, 29 months, or 36 months, depending on the qualifying event. Participant must pay employee and State contribution plus 2% administration charge.

Coinsurance

The amount you must pay as a portion of a health care expense. Coinsurance is applied to your maximum out-of-pocket.

Co-pay, Co-payment

The fixed or set amount you must pay before a plan will pay for specific services. Co-pays do not apply to maximum out-of-pocket.

Coverage, persons covered

An employee, retiree, COBRA enrollee, or dependent, who has met the eligibility requirements and is enrolled in a plan and to whom benefits are payable. This might include:

  • Single coverage Employee only
  • 2 party coverage Employee and spouse
  • 4 party coverage Employee and child(ren)
  • Family coverage Employee, spouse, and child(ren)
Cox-2 Inhibitor
Pre-authorization Program

Used to treat inflammation and reduce pain, and includes the brand name prescription medications Celebrex and Bextra. They work the same as drugs like naproxen and ibuprofen (non-steroidal anti-inflammatory drugs or NSAIDs). NSAIDs are a safe and effective choice to treat inflammation and/or reduce pain for the majority of people, and are several times less expensive. This program requires pre-authorization of benefits for Cox-2 drugs.

Deductible

The amount you must pay before health care expenses are paid by a plan.

Durable Medical Equipment (Durable Medical Goods)

Devices which are

  • Medically necessary for the treatment of a covered illness or injury
  • Very resistant to wear and may be used over a long period of time.

They include items such as wheelchairs, hospital beds, artificial limbs, etc.

Eligible Dependent

Eligible dependents include your:

  • Legal spouse
  • Children up to age 26
  • Children over age 26 who are mentally or physically disabled and dependent upon you for support
  • Step children, if the employee is enrolled in Family Coverage
  • Grandchild(ren) (for State health insurance benefits purposes only) if, and only if, the employee has legal custody, legal guardianship or court ordered custody of the grandchild(ren)
  • Legal Ward (must be your Legal Ward and have court appointed guardianship)
ESS
Employee Self Service

Employees can go online to view their pay stubs, personal profiles, current benefit elections, and leave balances. Employees can use ESS from any computer with internet access - at work or at home, at a family member's or friend's home, or at your local library. Every employee will need a userID and password to log on. Contact your Agency Human Resource Office for a userID and password.

Family Coverage

Employee + Spouse + Dependent Children.

Flexible Spending Account

A benefit offered to an employee by an employer which allows a fixed amount of pre-tax wages to be set aside for qualified expenses. Qualified expenses may include child care or out-of-pocket medical, dental, or vision expenses. The amount set aside must be determined in advance and employees lose any unused dollars in the account at year-end.

Formulary

Formulary (or preferred) brand name drugs are brand name medications that have higher copays than generics but are usually less costly than Non-formulary (or non-preferred) medications.

Four Party Coverage

Employee + Dependent Children.

Generics

Contain the same active ingredient as their brand name equivalents. Generics often help you save on your prescriptions. You get the same quality and effectiveness as that of a brand name drug, and help keep medical care more affordable for everyone.

Immediate Care or Urgency Care Clinic

Clinics offering extended office hours providing emergency or urgent care, which are usually not affiliated with local hospitals.

In-network benefits

Coverage when a provider is used within the plans' network.

Late entrant

If you do not sign up as a new hire or with a qualified event, you may be subject to a penalty. As a late entrant, you and/or your dependent(s) benefits will be limited to all preventive procedures for the first 12 months of coverage.

Maximum Out-of-Pocket

The amount of expenses you must pay (deductible + coinsurance) before a plan pays for all eligible expenses in full.

Maximum Lifetime Benefits

Total lifetime benefits available per covered person while contract is in effect.

Non-Formulary

Non-formulary (or non-preferred) medications have the highest copays and are not listed on Express Scripts' National Preferred Formulary List. Visit www.express-scripts.com to view the Formulary List.

Open Enrollment

A period during which eligible employees, retirees, and COBRA subscribers may make a change to current elections (certain limitations may apply).

Out-of-network benefits

Coverage when a provider is used outside of the plans' network.

Plan Year

July 1 through June 30.

PPO

Preferred Provider Organization A special arrangement between an insurer and hospitals, physicians and other health care professionals to pay for health care services, resulting in savings for the insured. PPO coverage (in-network benefits) does not require you to use a PPO doctor (out-of-network benefits).

Preauthorization

Process of obtaining approval by a carrier to determine if you are receiving the proper level of care in the appropriate setting.

Preadmission Certification

Requires you to pre-certify benefits for all non-emergency hospital and treatment center stays. Benefits for covered services may be reduced if not certified.

Pre-Existing Condition

A condition which is diagnosed or treated, or for which medication was prescribed or taken, previous to your application for coverage.

Premium

The amount a covered person pays in exchange for insurance coverage.

Provider

Any person (i.e., doctor, nurse, behavioral health provider, dentist) or facility (i.e., hospital or clinic) who provides medical, dental, vision, or behavioral care.

Qualified Event (status change)

A life event which may allow you to make a change to your current elections. Change must be consistent and on account of the event; change must be made within 30 days of event. Examples: marriage, birth or adoption, divorce or legal separation, unmarried dependent between ages of 19 and 24 years of age with a change in student status, change in employment status for you or your spouse, or change in provider (dependent care FSA).

Referral

Authorization from PCP to seek care from a specialists or another care provider.

Retiree (Early)

Allows for continuation of health/dental/vision/EAP/flex insurance for any covered employee who retires under the State of Nebraska Retirement System. Provides continuation for employee and covered dependent(s) until the employee reaches the age of 65.

Section 125 – IRS

Allows tax-sheltered deductions for health, dental, vision and FSA accounts; deductions are taken before Federal, State and FICA taxes are figured. Must have a qualified event to make changes to current elections.

Single Coverage

Employee only.

Two Party Coverage

Employee + Spouse.

UCR

Usual, Customary & Reasonable Charge(s) The amount allowed for payment for specific medical procedures within a specific geographical area.

  • This site contains information on coverage available to State employees who are eligible for insurance benefits.*
  • The State of Nebraska offers comprehensive insurance benefits to permanent*, full-time employees. Part-time employees who work 20 or more hours are also eligible for insurance benefits. Participation in the State's insurance program is voluntary. The State contributes 79% of the health insurance premium, 100% of the basic life insurance coverage, and 100% of the Employee Assistance Program cost (for participating agencies). All other insurance plans are offered to employees at a group rate.
  • Employees' contributions to the health and dental insurance plans are tax-sheltered under Internal Revenue Code 125. Anyone who participates in the health or dental insurance plans will pay their portion of the premium with before-tax dollars, which are automatically deducted from the employee's paycheck. The State also allows permanent employees to participate in two Flexible Spending Accounts, the Medical Reimbursement Account, and/or the Dependent Care Account. *
  • As a State of Nebraska employee, you will have the opportunity to select from insurance benefits listed for your specific employee-group type.

Benefits Home | Staff | Glossary | Notice of Privacy Practices

Disclaimer: The State of Nebraska does not have access to your personal health information.