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Key Terms
The Medical Plan pays benefits based on the allowable amount (sometimes referred to as “reasonable and customary charges”) for that service. When determining the allowable amount, the Claims Administrator considers factors such as the complexity of the treatment, the degree of skill needed to provide the treatment, the provider’s specialty, the range of services and supplies provided by the facility or provider, and the prevailing charge in the same area for that service. You will be responsible for any amounts over the allowable amount.
Under a benefit plan, the maximum benefit payable for a covered person during the plan year.
Annual Pay is your base pay determined by your employer; however, base pay excludes commissions, bonuses, overtime pay or any other extra compensation or income received from your employer. It is not your W-2 wages. If you are a commissioned salesperson, annual pay includes your base pay plus commissions but excludes renewal commissions. Commissions will be averaged for the 12-full calendar month period of your employment just before the date of loss or the period you actually worked for your facility, whichever is less. If you are a pieceworker, annual pay is based on your average monthly piecework earnings for the three months just prior to the date of loss.
A group or type of investment that all share the same risk and return characteristics and that are structured in essentially the same way. Three basic asset classes are cash (money market), bonds, and stocks.
Basic Living Expenses means shelter, utilities and all other costs directly related to the maintenance of the common household of the shared residence of the domestic partners. It also means any other cost, such as medical care, if some or all of the cost is paid as a benefit because a person is another person’s domestic partner.
The person or persons you name to receive any benefits provided by a benefit plan in the case of your death.
A financial instrument issued by a government or a company to borrow money. The bond specifies an interest rate that will be paid and the number of years (the bond’s term) until the bond will be repaid.
A benefit plan under Section 125 of the Internal Revenue Code that allows you to choose among two or more benefits consisting of cash and qualified benefits. Generally, cafeteria plans allow you to pay premiums for benefits on a before-tax basis and elections may only be changed during annual enrollment, except in limited circumstances.
A gain from disposition of an investment, equal to the excess of the sales price over the original cost.
Taxable money that you may receive if you waive certain benefits. Cash-Out Dollars are considered taxable income and will be taxed in the same way that your current pay is taxed. You can view the amount of Cash-Out Dollars available to you by logging on to LifeTimes Connection at HCArewards.com.
The company responsible for administering and paying claims under a benefit plan.
The percent of covered expenses that you must pay after the annual deductible, if applicable. For example, if the plan pays 80% of covered expenses, your coinsurance — after you pay your annual deductible — is 20%.
A fund that includes assets from several different accounts. The assets of participants are pooled together as a group and invested by several different investment managers that hold diversified portfolios to reduce management risk and expenses. Management risk can occur when a manager’s investment strategy is not performing in line with expectations of a particular investment category. Each manager will select securities using criteria unique to other strategies that can periodically expose investors to significant underperformance or out performance when compared to the fund’s benchmark.
The dollar amount that you pay to the network provider each time you receive a covered service — for example, a $15 copay for an office visit. The balance of the cost for care is usually paid at 100%. Copays do not count toward the deductible and there are no copay maximums.
Those expenses that are within the allowable amounts, medically necessary and otherwise eligible for reimbursement under a benefit plan.
The amount you pay toward covered expenses each year before the plan begins paying benefits.
You are considered disabled if your physical or mental condition qualifies as a total and permanent disability for benefits from the Social Security Administration and your disability occurred while you were employed by an HCA affiliate. You must prove your disability by supplying the letter from the Social Security Administration approving your eligibility for disability benefits to LifeTimes Connection.
Your disability earnings are the monthly earnings you receive from any employer or for any work while you are disabled and eligible for partial disability under the LTD Plan.
A payment by a company to an owner of its stock, as an investment return produced by the company’s profit.
Health & Group / Welfare Benefits: For purposes of the Plan, your eligible pay generally includes all wages reported on your W-2 form, including your contributions to the Plan and any before-tax dollars you use to pay for additional benefits through the LifeTimes Benefit Choices Program. Pay also includes any retention bonuses you receive. If your eligible pay increases during the year because of a raise or promotion, your contributions for the balance of the year are based on the increased amount. There are some exceptions to eligible pay. Retirement Benefits: For purposes of the Plan, your eligible pay generally includes all wages reported on your W-2 form. It also includes your contributions to the 401(k) Plan and any before-tax dollars you use to pay for benefits through the LifeTimes Benefit Choices Program. Retention bonuses are also considered eligible pay. Eligible pay does not include certain taxable non-cash compensation such as group life imputed income. Compensation that is eligible may include child care, meals reimbursement, and adoption reimbursement. If your eligible pay increases during the year because of a raise or promotion, your contributions for the balance of the year are based on the increased amount. There are some exceptions to eligible pay.
For purposes of the plan, eligible provider means a licensed, practicing physician. The definition includes:
Proof of physical condition or occupation provided to an insurance carrier to determine acceptance for coverage under Life Insurance and the Long-Term Disability Plan.
Any medical procedure, equipment, treatment or course of treatment, or drugs or medicines that are:
To determine whether a procedure is experimental, the Company will consider, among other things, commissioned studies, opinions and references to or by the American Medical Association, the federal Food and Drug Administration, the Department of Health and Human Services, the national Institutes of Health, the Council of Medical Specialty Societies and any other association or program or agency that has the authority to review or regulate medical testing or treatment.
Most prescription drugs have two names: a “generic” name that identifies the active chemical ingredient and a “brand name” used for advertising purposes. Generic equivalents have the same active ingredient, dosage form and strength as the brand-name drugs and generally cost less than brand-name drugs.
A growth fund attempts to produce long-term capital gains by investing in stocks that are generally considered to be growth stocks. Selection of such growth stocks involves following strategies that focus on companies that are experiencing significant earnings or revenue growth, rather than companies that pay out dividends. Growth funds tend to have more volatile returns than value funds and will often underperform the general equity market during a bear market or periods of economic contraction.
Growth stocks are typically companies that have high P/E ratios, and stocks that have gained popularity with mainstream investors, often due to changing investor preferences, a very positive quarterly earnings report, or growth in a particular industry. The prices of growth stocks tend to be more volatile than the prices of value stocks, meaning that growth stocks generally underperform the general equity market, as measured by the S&P 500 index, during a bear market or periods of economic contraction.
The term “HCA” refers to HCA Inc. and its affiliated facilities, unless otherwise stated. HCA Inc. is a holding company, which has no employees.
Expenses are treated as having been incurred when the participant is provided care that gives rise to the expenses, and not when the participant is formally billed or charged, or pays for the care.
Incapable of Caring for Oneself Incapable of caring for oneself means the person cannot dress, clean or feed themselves because of a physical or mental problem or must have constant attention to prevent them from injuring themselves or others
Under a benefit plan, the maximum amount payable for a covered person during the combined time of coverage.
LifeTimes Connection is HCA’s benefits information system that allows you to access automated information about your benefits through the Web site or interactive voice response system, or to speak to a Benefits Center Representative.
The Medical Plan pays benefits only for services that are “medically necessary.” To be considered “medically necessary,” a service or supply must:
The most you pay during a plan year for eligible expenses under a benefit plan. Copayments do not count toward the annual out-of-pocket maximum.
Indexed pre-disability earnings means your monthly earnings adjusted yearly by 10% or the current annual percentage increase in the Consumer Price Index, whichever is less. Your indexed earnings may increase or remain the same, but will never decrease. Indexing is used only to determine your percentage of lost earnings while you are disabled and working.
For the purposes of most benefit plans described in this Summary Plan Description (SPD), all references to Plan Administrator refer to HCA Inc.
Pre-disability pay is your monthly benefit pay for the last full pay period before the period of total disability begins. It does not include bonuses, overtime and any other extra compensation, nor does it include income received from sources other than HCA. If you’re a commissioned salesperson, your pre-disability pay includes income you actually receive from commissions, but it does not include renewal commissions, bonuses, overtime pay and any other extra compensation, nor does it include income received from sources other than HCA. If you’re a pieceworker, pay is calculated based on your average monthly piecework earnings for the three months prior to the period your disability begins.
The process of notifying the Claims Administrator before you receive care to ensure you receive the maximum benefits payable under the plan.
Price-Earnings Ratio (P/E Ratio) Shows the multiple of earnings at which a stock sells. It is determined by dividing current stock price by current earnings per share (adjusted for stock splits). Earnings per share for the P/E ratio are determined by dividing earnings for past 12 months by the number of common shares outstanding. A higher multiple often means investors have higher expectations for future growth, and have bid up the stock’s price.
The number produced by dividing the total value of a company’s outstanding stock by the company’s book value (with a company’s book value equal to the excess of its financial accounting assets over liabilities).
Reasonable and customary (R&C) limits are payment limits based on the prevailing rates charged for certain procedures. When R&C limits apply, reimbursements will not exceed these amounts. You will be responsible for paying the additional amount.
An unmanaged index commonly used as a benchmark to measure a growth stock manager’s performance. It includes the companies in the Russell 1000 Index (about 92% of the total estimated U.S market capitalization) with relatively higher price-to-book ratios and higher forecasted growth values.
An unmanaged index commonly used as a benchmark to measure a value manager’s performance. It includes the companies in the Russell 1000 Index (about 92% of the total estimated U.S market capitalization) with lower price-to-book ratios and relatively lower forecasted growth values.
An unmanaged index commonly used as a benchmark to measure a growth stock manager’s performance. It includes the companies in the Russell 2000 Index (about 8% of the total estimated U.S market capitalization) with relatively higher price-to-book ratios and higher forecasted growth values.
An unmanaged index commonly used as a benchmark to measure a value manager’s performance. It includes the companies in the Russell 2000 Index (about 8% of the total estimated U.S. market capitalization) with lower price-to-book values and lower forecasted growth values.
An unmanaged index commonly used as a benchmark to measure U.S. stock market performance. It includes a representative sample of 500 leading companies in leading industries of the U.S. economy.
See “Cafeteria” plan.
A share of ownership in a company or corporation. The price of a share of common stock is determined in the market by what other investors are willing to pay for it.
Totally and Permanently Disabled For purposes of the Plan, you are considered disabled if your physical or mental condition qualifies as a total and permanent disability for benefits from the Social Security Administration and your disability occurred while you were employed by an HCA affiliate. You must prove your disability by supplying the letter from the Social Security Administration approving your eligibility for disability benefits to LifeTimes Connection.
Totally disabled means that, as a result of an injury, a sickness or a disorder, your dependent:
A value fund attempts to produce long-term capital gains and current income through dividends by investing in stocks that are generally considered to be value stocks. Selection of such value stocks involve following strategies that focus on companies that appear underpriced by fundamental measures. Assuming that a company’s share price will not remain undervalued indefinitely, the fund looks to make money by buying before the expected upturn. A value fund tries to focus on relative safety rather than growth, and often chooses stocks providing dividends as well as capital appreciation. Value funds tend to have less volatile returns than growth funds and will often underperform the general equity market, as measured by the S&P 500 index, during a bull market or periods of rapid economic growth.
Value stocks are typically companies that have low P/E ratios and have fallen out of favor with mainstream investors, often due to changing investor preferences, a poor quarterly earnings report, or hard times in a particular industry. Value stocks are often mature companies that have slowed or stopped growing and that use their earnings to pay dividends.
The relative rate at which the price of a fund or its underlying securities move up and down. If the price moves up and down rapidly over short time periods, it has high volatility. If the price almost never changes, it has low volatility.
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