Having trouble understanding your plan details? Look up any confusing terms here. You can also always contact the Employee Service Center at 1-800-999-4734, ext. 4747 (Mon. to Fri., 8 am–4:30 pm PT), or email@example.com.
The amount of money that is deducted from your paycheck for the benefits you choose.
A federal law that gives you and your dependents the right to continue health care coverage through REI at your own cost. It applies after certain events (like employment ending) that would otherwise cause you to lose health care coverage.
A portion of the cost of health care services (excluding in-network preventive care) that you pay after meeting your plan deductible (if applicable). So, if your plan has 80/20 coinsurance, your plan pays for 80% of your eligible in-network medical expenses and you pay the remaining 20%.
A medical plan that allows consumers to control health care costs by making smart decisions about the care they receive. This type of plan has a high deductible, but gives employees access to a tax-advantaged account called a Health Savings Account (HSA).
A flat dollar amount that you pay when you receive a health care service (like when you visit the doctor or fill a prescription).
A flat dollar amount you pay for health care services each plan year before your health plan will pay any benefits for you (excluding in-network preventive care).
Information about your health status that you may need to provide to the insurance company when you enroll in a life insurance, disability or long term care plan. The insurance company must approve your EOI application before you can enroll in the plan.
An account that lets you set aside money from your paycheck on a pre-tax basis to pay for eligible health care or dependent care expenses. Using an FSA reduces your total taxable income, so you pay less tax and take home more pay.
A type of medical plan that features a network of doctors, hospitals and other providers. To get benefits, you have to use a provider in the plan’s network. For REI, only California, Colorado and Washington have a regional HMO option.
A tax-advantaged account for individuals enrolled in a Consumer-Directed Health Plan, such as the REI Saver Health Plan. The money in the account can be used to pay for qualified health care expenses.
A provider that is part of a health plan’s network. You generally save money when you use an in-network provider.
A committed, “spouse-like” relationship with an adult of the same or opposite gender. For your life partner to qualify for REI benefits, your life partnership must meet the definition outlined in REI’s Summary Plan Description and Life Partner Affidavit.
Certain REI-provided benefits that the IRS considers as income for calculating your federal and state (if applicable), Social Security and Medicare (FICA) taxes. The value of the benefit is listed on your paycheck as taxable income; however, you do not receive the additional income as cash. For life insurance, any amount over $50,000 for employee coverage and any value for spouse/life partner or dependent coverage is included as imputed income.
A Flexible Spending Account that is limited to dental and vision expenses because the participant is enrolled in the REI Saver Medical Plan also uses a Health Savings Account.
You have 30 days from when you become eligible to enroll in REI benefits.
This is the time each year when you can make changes to your benefit elections for the next plan year. It occurs every November 1–15.
Any doctor, hospital or other provider that isn’t part of a health plan’s network. You generally pay more when you use an out-of-network provider, and some plans (such as HMOs) don’t cover your expenses when you use out-of-network providers.
The maximum amount of money you have to pay in health care expenses in a plan year before your medical plan pays 100% of your covered expenses for the rest of that year. It’s a safety net that limits how much you have to pay if you have high medical costs.
A primary care physician, or PCP, is the doctor who provides most of your medical care and coordinates any other care you may need. PCPs often have specialties in general internal medicine, family practice, general practice and/or pediatrics.
A type of medical plan that features a network of doctors, hospitals and other providers. You typically pay less when you use a provider in the plan’s network. The REI Choice Medical Plan is an example of a PPO.
When benefit contributions are deducted from your paycheck before taxes are calculated. This reduces your total taxable income, so you pay less tax and take home more pay.
The average charge for a procedure in a particular geographic area. If you use out-of-network providers and they charge more than the R&C amount, you are responsible for your portion of the coinsurance plus any amount above the R&C amount.
Your one-stop personal guide that helps you navigate your way through benefits and health care and directs you to appropriate resources.
A doctor who has completed advanced education and clinical training in a specific area of medicine (for example, obstetrics and gynecology, oncology or neurology). In most HMO plans, you need a referral from your primary care physician (PCP) in order to see a specialist.
An official description of REI benefit plans. If there’s a discrepancy between this site and the SPD content, the SPD governs.
A free and confidential program (offered through Aetna) to help you manage personal issues like depression, substance abuse or stress.
Part-Time Employees’ Benefits Eligibility
Employees who have averaged 20 or more hours worked during their evaluation period will be covered under the REI Benefits Plan for 12 months.
Hours tracked over a defined 12-month period to determine benefits eligibility for part-time employees. The 12-month time period is called an evaluation period, defined below. If a part-time employee works on average 20 or more hours per week during their evaluation period, they are eligible for benefits.
The time REI needs to review your hours and process your eligibility. This occurs at the end of your initial and ongoing evaluation period and before your coverage begins.
A defined 12-month period. Hours are tracked during this period to determine benefits eligibility for part-time employees. An employee’s evaluation of hours is determined based on how long an employee has been with REI:
- Ongoing Evaluation Period: Always occurs from October 4–October 3 of each year and applies to employees who have been with REI longer than 12 months.
- Initial Evaluation Period: Corresponds with an employee’s date of hire (or rehire date if the employee has been separated from REI for more than three months).
For example, if an employee was hired/rehired on April 15, 2019, he/she will have an initial evaluation period between May 1, 2019–April 30, 2020. Typically, employees will only have one initial evaluation period, which will catch them up to the ongoing evaluation period that is reviewed in October of each year.
Health Care Reform
A federal law enacting comprehensive reform of health insurance in America. According to the Federal Health Care Reform website (healthcare.gov), some of the goals of the legislation include holding insurance companies accountable, lowering health care costs, guaranteeing more coverage choices and enhancing the quality of medical care. It includes requirements for individuals, employers, insurance companies and health plans. The “individual mandate” requires most Americans to have health insurance beginning in 2014.
Insurance coverage for family members of the policyholder, such as spouse, children or partner.
Generally speaking, household income means the adjusted gross income you report for the year on your federal tax return on line 37 of the IRS Form 1040 for you, your spouse and your tax dependents. (Line 21 on Form 1040A and Line 4 on 1040EZ). To determine your adjusted gross income for a year, calculate your taxable income, such as wages, unemployment compensation, Workers’ Compensation, Social Security benefits, self-employment and other business income, interest, dividends, and alimony and rental income. Then subtract expenses from your taxable income, such as contributions to IRAs, moving expenses, student loan interest and alimony paid to determine your adjusted gross income. It’s your responsibility to understand which income and expenses affect your adjusted gross income. To learn more, check out the federal Marketplace site or speak to a tax advisor.
Your household size includes you and any individuals who are claimed as dependents on your federal income tax return. It’s your responsibility to determine who is in your household for income tax purposes. To learn more, check out the federal Marketplace site or speak to a tax advisor.
A tax credit to help individuals afford health coverage purchased through the Marketplace. Advance payments of tax credits can be used immediately to lower premium costs. The amount of savings an individual is eligible for is provided during the Marketplace application process. (NOTE: If an employee is eligible for REI’s benefits, they will not be eligible for the subsidy.)
A change in your life that makes you eligible for a special enrollment period either through REI or the government. Includes marriage, the birth or adoption of a child or gain or loss of other employer coverage.