Glossary: S

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Salary continuation This is for when employees are disabled for a short time. The employer pays part or all of the employees’ salary.

Schedule of benefits and exclusions This list states what a policy does and does not cover.

Second (surgical) opinion This is an opinion you get from a second doctor. You get this after you receive an opinion from the first doctor you went to see. It gives you a chance to compare the two opinions. Then, you can decide how you want to treat your problem.

Section 213(d) This is a part of the Internal Revenue Code. It lists what type of medical expenses people can deduct from their taxes. It applies to plans with an FSA, HRA, HSA or MSA. See “ Qualified medical expense.”

Self-funded plan See “Self-insured plan.”

Self-insured employer This is an employer who pays benefit claims for his or her employees. The employer takes on most, or all, of the risk of the costs of benefit claims. The benefit company manages those payments.

Self-insured plan This is also called a “self-funded plan.” This is a type of plan in which the employer takes on most, or all, of the costs of benefit claims. The benefit company manages the payments. But the employer is the one who pays the claims. These plans are often more flexible for the employer. That is because the employer is oftentimes not subject to state law requirements.

SEP See “Special election period.”

Service area This is an area served by a health plan. It is where the plan is licensed to accept members. It is also where a network of doctors exists to give health care services.

Short-term disability (STD) This pays part of a worker’s pay when he or she is out of work. This person must be out of work for a short time with an illness or injury that is not related to work.

Short-term health insurance This is a type of health care plan that fills gaps in a regular plan. It gives you benefits when you are between jobs, after a move or when you are out of the country. It usually lasts for one year or less. And it usually cannot be renewed.

Sickness This is a condition for which you would need medical care.

Skilled nursing facility (SNF) This is a place that gives nursing care to people who do not need to be in a hospital. It is licensed. It gives rehabilitation and other care, too. It does not include nursing homes or care for those who need help with daily living.

Small business health insurance This is health insurance for companies that have 2 to 50 employees. These plans help employers save on their taxes. And they help employees save on their premiums.

SMI See “Supplemental medical insurance.”

SNF See “ Skilled nursing facility.”

SNP See “ Special needs plan.”

Social Security retirement benefits This is a retirement program run by the government. It is paid for through federal income tax money. It gives Americans a check each month based on the years they have worked and the money they have earned during their life.
Age 62 is the earliest age to receive Social Security. Employers decide the age when a person can receive full benefits. If a person has earned more money in their life, money in the Social Security check may be higher. If they have earned less, their check amount may be lower.

Special benefit networks These are groups of doctors, specialists or health centers. They give care for special services. For example, services could be for mental health and drug abuse.

Special election period (SEP) This is for people with a Medicare plan. It is a time when they can change their benefits because something in their life changes. Examples are moving out of a plan service area, or being able to get Medicaid. If nothing in their life changed, they must wait for an enrollment period.

Special needs plan (SNP) This is a Medicare Advantage HMO or PPO plan. It is for smaller groups of people who get Medicare. There are three types of these plans. The first type is for those who receive both Medicare and state Medicaid. The second type is for those who live in a long-term care home. The third type is for those with a condition that is disabling.

Specialist This is a doctor who is trained to give care in a specific medical area. The doctor’s focus could be on a disease, part of the body or age group.

Speech therapy This is treatment to fix something that is wrong with a person’s speech. The problem could have started from birth. But it could also have been from a disease, an earlier medical treatment or a time when the person got hurt.

Staff model This is a type of HMO plan. Doctors who give care are employees of the HMO. This is different from an “ independent practice association (IPA)” HMO. In an IPA-model HMO, the doctors who give care are not employees of the HMO.

Standard industrial classification (SIC) The U.S. government uses this system to classify, or group, industries. They are grouped by their products or services.

State insurance department This is an agency that makes state insurance laws. It also makes sure insurance companies follow the laws in their state.

State-mandated benefits These are benefits a state requires in a policy. If the benefit is not in the policy, it cannot be sold in the state.

STD See “ Short-term disability.”

Step therapy This is a way that a health plan controls drug costs. It means a person must try certain drugs before a particular brand-name drug will be paid for by the plan. The first drugs are often generic and cost less.

Stop-loss coverage This protects employers who take on most of the risk of a health plan. An employer can buy this to avoid having to pay for large health claims. If health care costs go over the amount listed in the contract, the plan will pay the rest.

Subscriber This is a person who signs up for a health plan. If the plan is a family health plan, the person can add people to it as dependents. Those people must be eligible to be added. Some health plans also use the word “enrollee” for this term.

Successive disabilities This is when a person is disabled two or more times. Each time is due to the same condition. Or each time can happen because of a related condition. Each episode is separated by a time period that is stated in the contract.

Supplemental life insurance This is extra life insurance. An employee can buy this to get more than the basic amount given by his or her employer.

Supplemental medical insurance (SMI) This is also called Medicare Part B. This insurance covers basic medical needs. It is paid by both the insured person and the government.

Survivor benefit This has to do with a disability plan. It pays money to a living person if the person who holds the policy dies. The living person’s name is on the policy.

Glossary: S

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Salary continuation	This is for when employees are disabled for a short time. The employer pays part or all of the employees’ salary.
Schedule of benefits and exclusions	This list states what a policy does and does not cover.
Second (surgical) opinion	This is an opinion you get from a second doctor. You get this after you receive an opinion from the first doctor you went to see. It gives you a chance to compare the two opinions. Then, you can decide how you want to treat your problem.
Section 213(d)	This is a part of the Internal Revenue Code. It lists what type of medical expenses people can deduct from their taxes. It applies to plans with an FSA, HRA, HSA or MSA. See “ Qualified medical expense.”
Self-funded plan	See “Self-insured plan.”
Self-insured employer	This is an employer who pays benefit claims for his or her employees. The employer takes on most, or all, of the risk of the costs of benefit claims. The benefit company manages those payments.
Self-insured plan	This is also called a “self-funded plan.” This is a type of plan in which the employer takes on most, or all, of the costs of benefit claims. The benefit company manages the payments. But the employer is the one who pays the claims. These plans are often more flexible for the employer. That is because the employer is oftentimes not subject to state law requirements.
SEP	See “Special election period.”
Service area	This is an area served by a health plan. It is where the plan is licensed to accept members. It is also where a network of doctors exists to give health care services.
Short-term disability (STD)	This pays part of a worker’s pay when he or she is out of work. This person must be out of work for a short time with an illness or injury that is not related to work.
Short-term health insurance	This is a type of health care plan that fills gaps in a regular plan. It gives you benefits when you are between jobs, after a move or when you are out of the country. It usually lasts for one year or less. And it usually cannot be renewed.
Sickness	This is a condition for which you would need medical care.
Skilled nursing facility (SNF)	This is a place that gives nursing care to people who do not need to be in a hospital. It is licensed. It gives rehabilitation and other care, too. It does not include nursing homes or care for those who need help with daily living.
Small business health insurance	This is health insurance for companies that have 2 to 50 employees. These plans help employers save on their taxes. And they help employees save on their premiums.
SMI	See “Supplemental medical insurance.”
SNF	See “ Skilled nursing facility.”
SNP	See “ Special needs plan.”
Social Security retirement benefits	This is a retirement program run by the government. It is paid for through federal income tax money. It gives Americans a check each month based on the years they have worked and the money they have earned during their life. Age 62 is the earliest age to receive Social Security. Employers decide the age when a person can receive full benefits. If a person has earned more money in their life, money in the Social Security check may be higher. If they have earned less, their check amount may be lower.
Special benefit networks	These are groups of doctors, specialists or health centers. They give care for special services. For example, services could be for mental health and drug abuse.
Special election period (SEP)	This is for people with a Medicare plan. It is a time when they can change their benefits because something in their life changes. Examples are moving out of a plan service area, or being able to get Medicaid. If nothing in their life changed, they must wait for an enrollment period.
Special needs plan (SNP)	This is a Medicare Advantage HMO or PPO plan. It is for smaller groups of people who get Medicare. There are three types of these plans. The first type is for those who receive both Medicare and state Medicaid. The second type is for those who live in a long-term care home. The third type is for those with a condition that is disabling.
Specialist	This is a doctor who is trained to give care in a specific medical area. The doctor’s focus could be on a disease, part of the body or age group.
Speech therapy	This is treatment to fix something that is wrong with a person’s speech. The problem could have started from birth. But it could also have been from a disease, an earlier medical treatment or a time when the person got hurt.
Staff model	This is a type of HMO plan. Doctors who give care are employees of the HMO. This is different from an “ independent practice association (IPA)” HMO. In an IPA-model HMO, the doctors who give care are not employees of the HMO.
Standard industrial classification (SIC)	The U.S. government uses this system to classify, or group, industries. They are grouped by their products or services.
State insurance department	This is an agency that makes state insurance laws. It also makes sure insurance companies follow the laws in their state.
State-mandated benefits	These are benefits a state requires in a policy. If the benefit is not in the policy, it cannot be sold in the state.
STD	See “ Short-term disability.”
Step therapy	This is a way that a health plan controls drug costs. It means a person must try certain drugs before a particular brand-name drug will be paid for by the plan. The first drugs are often generic and cost less.
Stop-loss coverage	This protects employers who take on most of the risk of a health plan. An employer can buy this to avoid having to pay for large health claims. If health care costs go over the amount listed in the contract, the plan will pay the rest.
Subscriber	This is a person who signs up for a health plan. If the plan is a family health plan, the person can add people to it as dependents. Those people must be eligible to be added. Some health plans also use the word “enrollee” for this term.
Successive disabilities	This is when a person is disabled two or more times. Each time is due to the same condition. Or each time can happen because of a related condition. Each episode is separated by a time period that is stated in the contract.
Supplemental life insurance	This is extra life insurance. An employee can buy this to get more than the basic amount given by his or her employer.
Supplemental medical insurance (SMI)	This is also called Medicare Part B. This insurance covers basic medical needs. It is paid by both the insured person and the government.
Survivor benefit	This has to do with a disability plan. It pays money to a living person if the person who holds the policy dies. The living person’s name is on the policy.