Appendix H Definitions.pdf

APPENDIX H

DEFINITIONS

The following definitions are only for the purpose of this Request for Proposal, and its attachments and appendices.

Adopting Employer The Executive Branch of the Federal Government. Adopting

Employer also means an Employer that signs an adoption agreement, accepted by OPM, to participate in this Plan. An Employer remains an Adopting Employer until the Plan terminates, the Adopting Employer withdraws from the Plan, or OPM terminates the Adopting Employer’s participation in the Plan.

Agency(ies) Departments and independent agencies of the Federal Government, including the Tennessee Valley Authority, but not including the D.C.

Government.

Allotment Also called an election. The total amount of pre-tax gross income a participant puts into their FSAFEDS flexible spending account for the benefit period.

Annuitants Federal retirees (who retired on an immediate annuity), and survivors (of those retired on an immediate annuity) receiving annuity compensation. Also includes those receiving compensation from the Department of Labor. Sometimes called retirees.

BC Benefits Counselor. Also called a Customer Service Representative or

CSR.

BENEFEDS An enrollment and premium administration portal contracted by OPM Covered Employee Under FedFlex, means an individual who is an employee under

Section 2.9, is employed by an executive branch or Adopting Employer, and satisfies coverage requirements under Article 3.

CSR Customer Service Representative. Also called BC.

DCFSA Dependent Care Flexible Spending Account EFT Electronic Funds Transfer.

Election Also called an allotment. The total amount of pre-tax gross income a participant puts into their FSAFEDS flexible spending account for the benefit period.

Employee Under FedFlex, for purposes of the Health Care Flexible Spending Account, and no other purpose, an employee is as defined in 5 USC section 8901(1); except that Employee does not include: employees of the judicial branch, employees of the District of Columbia government, or employees not eligible to participate in the FEHB Program in accordance with applicable statutes and regulations; or a Reemployed Annuitant.

For purposes of the Dependent Care Flexible Spending Account, and no other purpose, an employee as defined in 5 USC section 8901(1);

except that Employee does not include: employees of the judicial branch, employees of the District of Columbia government, or intermittent employees with no fixed work schedule whose tour of duty is expected to be 180 days or less; a Reemployed Annuitant, or when in pay status in accordance with 37 U.S.C. Section 204, an employee who is a uniformed service member of the regular component of the Army, Marine Corps, Navy, Air Force, or Space Force, or of the Reserve component performing active Guard and Reserve duty, as defined at 10 U.S.C. Section 101(d)(6), pursuant to 10 U.S.C. Section 12301(d). Active Guard and Reserve.

Employee Express A portal used by some agencies that allow employees to initiate the processing of their discretionary personnel-payroll transactions electronically.

Employer Any Agency whose employees are eligible to elect a health care and/or dependent care FSA under the Federal Flexible Benefits Plan (FedFlex). In the case of an employee whose payroll office is not an Executive Branch payroll office, the employer is the entity that issues pay on behalf of the Employee.

FedFlex Federal Flexible Benefits Plan (FedFlex) is a cafeteria benefits plan document under Section 125 of the Internal Revenue Code. OPM enhanced FedFlex to implement health care and dependent care flexible spending accounts in 2003.

FEDVIP Federal Employees Dental and Vision Insurance Program FEGLI Federal Employees' Group Life Insurance FEHB Federal Employees Health Benefits FLTCIP Federal Long Term Care Insurance Program FSA A health care or dependent care Flexible Spending Account, as allowed by Internal Revenue Code Section 125.

FSAFEDS The Federal Flexible Spending Account Program offered to eligible employees of an employer, as determined by OPM.

FSAFEDS Fund Also called “All Program Funds” held by the Contractor, excluding

Contractor fees. The aggregate of all FSAFEDS participant account funds, any loan balance from the Risk Reserve and participant forfeitures, including all applicable interests.

GAO United States Government Accountability Office Grace Period An additional 2 ½ months (January 1 through March 15) during which

FSAFEDS participants can incur eligible expenses that can be reimbursed from the prior year balance.

HCFSA Health Care Flexible Spending Account HIPAA Health Insurance Portability and Accountability Act IPAC Intra-Governmental Payment and Collection IVR Interactive Voice Response System LEX HCFSA Limited Expense HCFSA. A LEX HCFSA is considered to be an

HCFSA.

LTC Long term care OPM United States Office of Personnel Management.

Paperless Reimbursement

(PR)

The process by which participating FEHB and FEDVIP carriers regularly submit claims data to the Contractor on behalf of their FSAFEDS-participating members. The data includes all information required by the Contractor to process a health care FSA claim, including date of service, type of service, and patient out-of-pocket liability. The Contractor uses this data to automatically adjudicate claims and reimburse health care FSA participants for eligible expenses without the need for the participant to submit a manual claim.

Plan Agent A third party administrator under contract to OPM to provide designated administrative services with regard to the Plan.

Plan Year A 12-month period ending on each December 31. The plan year may be extended 2 ½ months by a grace period in some situations.

PHPM Per HCFSA Per Month PMPM Per Member Per Month Qualifying Life Event

Also called a QLE. An event defined by the Internal Revenue Service in Internal Revenue Code, Section 125 that allows participants to change their flexible spending account election outside of the annual Open Season.

Reemployed Annuitant

An individual who is retired from the Federal Government, is reemployed as an employee as defined in 5 USC 8901(1), and who continued to receive an annuity.

Risk Reserve OPM’s FSAFEDS funds. Sometimes referred to as Risk Reserve Account. This account holds all of the FSAFEDS program funds except the participants’ allotments and Contractor fees.

SOB Summary of Benefits