Your Compliance Edge

All Terms

- A -

Ability: A present competence to perform an observable behavior or a behavior which results in an observable product.
Categories: Human Resource

Accepted condition: A medical condition for which an insurer accepts responsibility for the payment of benefits on a claim filed by an injured worker (also called accepted claim).
Categories: Workers Compensation

Accessibility: The absence of access barriers. When a site, building or portion thereof complies with ADA guidelines.
Categories: Diversity

Accident: An event, arising out of and in the course of employment, that results in personal injury to a worker.
Categories: Workers Compensation

Action Item: Specific activity initiated to achieve an objective.
Categories: Human Resource

Adaptive Device: Any tool or implement which facilitates greater efficiency by an individual with a disability in the performance of duties.
Categories: Human Resource

Administrative law judge: An employee of the Workers' Compensation Board who makes decisions about workers’ compensation disputes and approves settlements (also called workers’ compensation judge). May also review appealed administrative orders, hold impartial hearings, and issue legal opinions.
Categories: Workers Compensation

Administrative Simplification: Title II, Subtitle F, of HIPAA, which gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. This is also the name of Title II, Subtitle F, Part C of HIPAA.
Categories: HIPAA

Adverse Impact: Adverse impact, exists where " a substantially different rate of selection in hiring, promotions or other employment decisions works to the disadvantage of members of a protected group." An "inference of adverse impact"occurs in the absence of such data and is determined by calculating the extent of a group's representation or utilization in a given occupation based on the availability of its members in the relevant labor market.
Categories: Human Resource

Adverse Impact (effect):: When certain personnel or program eligibility policies (e.g., word-of-mouth recruiting, diploma requirements, intelligence tests, minimum height requirements, disproportionate terminations or layoffs) have the effect of denying employment, advancement or services to Protected Class Members.
Categories: Diversity

Adverse Treatment: An action that would in any way deprive an individual of employment, educational opportunity or services which they were otherwise eligible to receive or negatively affect his or her status.
Categories: Diversity

Affected Group (or Class): Any group in the population shown to suffer the effects of past or present discrimination.
Categories: Human Resource

Affirmative Action: The development of a program through which an employer acts to affirm the contributions that a diverse workforce can bring to a work environment. This is accomplished by taking specific steps to identify, recruit, hire and/or develop for advancement, persons who are identified as part of specific protected classes. Thus, an employer demonstrates its willingness to remedy past acts of discrimination against specific groups by developing goals and timetables, and mechanisms through which success is measured, with an ultimate goal of achieving a diverse workforce.
Categories: Diversity

Affirmative Action File: A file maintained by an agency to document affirmative action efforts.
Categories: Human Resource

Affirmative Action Officer: An individual in the agency who has primary responsibility for development and maintenance of the agency's affirmative action plan.
Categories: Human Resource

Affirmative Action Plan: The document, required by Executive Order No. 478, from appointing authorities of agencies which provides the method for implementation of Affirmative Action.
Categories: Diversity

Affirmative Action Program: The implementation of an Affirmative Action Plan.
Categories: Diversity

Affordable Care Act (ACA): The comprehensive health care reform law enacted in March 2010.
Categories: Health Insurance

Affordable Coverage: An employer-sponsored health plan covering only the employee, the cost of which does not exceed a set annual percentage or less of the employee's household income. Click here for more information.
Categories: Health Insurance

Aggravation claim: A claim for further benefits because of a worsening of the claimant's accepted medical condition after the claim has been closed.
Categories: Workers Compensation

Allowed Amount: The maximum amount a plan will pay for a covered health care service. If a provider charges more than the plans allowed amount, the plan participant may have to pay the difference through a process called balance billing.
Categories: Health Insurance

Alternative dispute resolution (ADR): A voluntary process through which parties resolve disputes instead of using the formal hearing process.
Categories: Workers Compensation

American Indian/Alaskan Native: All persons having origins in any of the original peoples of North America who maintain cultural identification through tribal affiliation or community recognition.
Categories: Human Resource

American National Standards Institute (ANSI): An organization that accr edits various standardssetting committees, and monitors their compliance with the open rule-making process that they must follow to qualify for ANSI accreditation. HIPAA prescribes that the standards mandated under it be developed by ANSI-accredited bodies whenever practical. Committee and also helps maintain the HCPCS Level II codes.
Categories: HIPAA

Americans with Disabilities Act (ADA): Prohibits discrimination against persons with disabilities in employment, government programs, public accommodation, telecommunications, and transportation.
Categories: Human Resource

Americans with Disabilities Act (ADA): A federal law that prohibits discrimination against people with disabilities and directs employers to make reasonable accommodations for people with disabilities.
Categories: Workers Compensation

Americans with Disabilities Act (ADA) Public Law 101-336: Legislation that gives civil rights protections to individuals with disabilities similar to those provided to individuals on the basis of race, sex, national origin and religion. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, state and local government services and telecommunication.
Categories: Diversity

Amplified Telephone: A telephone, which is equipped with a sound amplification device, such as an amplified headset or a freestanding amplifier.
Categories: Diversity

Ancillary care: Care such as physical or occupational therapy provided by a health care provider other than the attending physician, specialist physician, or authorized nurse practitioner.
Categories: Workers Compensation

Annual Limit: A cap on the benefits an insurance company will pay in a year while a plan participant is enrolled in a particular health insurance plan. Annual limits are sometimes placed on particular services such as prescriptions or hospitalizations, on the dollar amount of covered services, or on the number of visits that will be covered for a particular service. After an annual limit is reached, the plan participant must pay all associated health care costs for the rest of the year.
Categories: Health Insurance

Appeal: A legal action taken by one of the parties to reverse or amend a decision or direction in regards to a workers' compensation claim.
Categories: Workers Compensation

Applicant: A person who registers personal information and qualifications with the state and who applies for a specific vacancy (K.A.R. 1-2-8).
Categories: Human Resource

Applicant Flow Log: A chronological compilation of applicants for employment or promotion, showing the persons categorized by race, sex and ethnic group, who applied for each job title (or group of job titles requiring similar qualifications) during a specific period.
Categories: Human Resource

Applicant Pool: Those persons who have applied for a particular position or who have applications on file from which an employee may be selected.
Categories: Diversity

Appointing Authority: A person or group of persons empowered by the constitution, by statute, or by lawfully delegated authority to make human resource decisions that affect state service (K.A.R. 1-2-9).
Categories: Human Resource

Apportionment: A proportionate division of all or part of the liability in a case between two or more sources of disability for the same claimant, based on an evaluation of the relative contribution that the sources of disability have made to the claimant's permanent disability.
Categories: Workers Compensation

Architectural Barrier: Any non-job related consideration which excludes from employment individuals otherwise capable of doing the work.
Categories: Human Resource

Arising out of and in the course of employment (AOE/COE): Two necessary conditions that must be met to establish a work-connected accidental injury; an injury that "arises out of" is one that results from a hazard of the employment, while an injury "in the course of employment" is one that occurred at a time, place and under circumstances related to the employment.
Categories: Workers Compensation

Asian or Pacific Islander: Having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent, or the Pacific Islands.
Categories: Diversity

Assistive Listening Device: A device that enhances hearing, such as a personal system, which can be used for listening to television, attending meetings with speakers and round-table discussions. Group assistive listening systems provide listening for groups or certain individuals in groups (ex: audio loop).
Categories: Diversity

Attending physician: A health care provider primarily responsible for the treatment of an injured worker (also called primary treating physician or treating physician).
Categories: Workers Compensation

Audio Loop: An assistive listening system consisting of a continuous length of wire that acts as an antenna for an audio receiver system to which individual receivers can be attached. Used in conference, classroom settings by individuals who are hard of hearing.
Categories: Diversity

Authorization: An authorization by the patient is required for most non-routine disclosures of PHI
Categories: HIPAA

Automatic enrollment: As soon as eligibility requirements are met, employees become automatically covered under a plan, but have the right to decline coverage at any time. A minimum default employee contribution usually is set, but employees may choose to contribute a different percentage.
Categories: Retirement Benefits

Availability: The presence of protected class members "ready, willing and able to work" used in setting goals and determining Underutilization and Parity.
Categories: Diversity

Availability Standard: A percentage figure depicting a group's availability in the relevant labor market who are qualified under valid, job-related criteria.
Categories: Human Resource

Average weekly wage (AWW): Average weekly wage of workers in covered employment which may be used to calculate benefit rates for temporary disability, permanent partial disability, permanent total disability, and death.
Categories: Workers Compensation

- B -

Back Pay: Compensation for past economic losses, such as lost wages, fringe benefits, etc, caused by discriminatory employment practices.
Categories: Human Resource

Balance Billing: When a provider bills a patient for the difference between the provider's charge and the patient's insurance plan's allowed amount. For example, if the provider's charge is $100 and the patient's insurance plan's allowed amount is $70, the provider might bill the patient for the remaining $30.
Categories: Health Insurance

Barrier: Any obstacle to the realization of a person's full potential. Bias: A settled and often prejudiced outlook.
Categories: Human Resource

Beneficiary: An injured worker's spouse, domestic partner, child, or dependent entitled to receive payments under workers' compensation law.
Categories: Workers Compensation

Benefit payment methods: Payments from defined benefit plans may be in the form of a straight life annuity, a joint-and-survivor annuity, a percentage of the unreduced accrued benefit, or a lump sum.
Categories: Retirement Benefits

Black: Having origins in any of the Black racial groups of Africa or the Cape Verde Islands.
Categories: Diversity

Black (Not of Hispanic Origins): All persons having origins in any of the black racial groups of Africa.
Categories: Human Resource

Bona Fide Occupational Qualification (BFOQ): Any prerequisite which has been demonstrated valid as a qualification for employment.
Categories: Human Resource

Braille: A reading method for the blind predicated on the use of a six-dot cell, using the dots in various combinations. Also, a code using short form words, letter combination abbreviations, special signs to indicate capitalization and other punctuation. To be read by touch.
Categories: Diversity

Brand-Name Drug: A drug sold by a drug company under a specific name or trademark and that is protected by a patent. Brand-name drugs may be available by prescription or over the counter.
Categories: Health Insurance

Burden of Proof: In discrimination cases, the plaintiff must show that an action, practice or policy used by the employer has an adverse impact. Once adverse effect is shown, the burden of proof shifts to the employer who must show that the action, practice or policy is job related.
Categories: Human Resource

Business Associate: A person or organization that performs a function or activity on behalf of a covered entity, but is not part of the covered entity’s workforce. A business associate can also be a covered entity in its own right.
Categories: HIPAA

Business Necessity: Justification for an otherwise prohibited employment practice based on proof that the otherwise prohibited employment practice is essential for the safety and efficiency of the business and that no reasonable alternatives with a lesser impact exist.
Categories: Diversity

Business Necessity: Under the Uniform Guidelines on Employee Selection Procedures: "Necessary to the safe and efficient operation of the business, that it effectively carries out the purpose it is suppose to serve and that there are no alternative policies or practices which would better or equally well serve the same purpose with less discriminatory impact".
Categories: Human Resource

- C -

Career earnings formulas: Benefits are based on a percentage of an average of career earnings for every year of service recognized by the plan.
Categories: Retirement Benefits

Career path: A career path identifies optimum alternative paths of employee progression to positions requiring successively higher levels of skill and the consequent promotional opportunities (K.A.R. 1-2-15).
Categories: Human Resource

Cash balance plans: Benefits are computed as a percentage of each employee's account balance. Employers specify a contribution, and a rate of interest on that contribution, that will provide a set amount at retirement, generally as a lump sum.
Categories: Retirement Benefits

Chain of Trust: A term used in the HIPAA Security NPRM for a pattern of agreements that extend protection of health care data by requiring that each covered entity that shares health care data with another entity require that that entity provide protections comparable to those provided by the covered entity, and that that entity, in turn, require that any other entities with which it shares the data satisfy the same requirements. encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes. This includes both the codes and their descriptions.
Categories: HIPAA

Childcare assistance: Provides either the full or partial cost of caring for an employee's children in a nursery or daycare center or by a babysitter. Care can be provided in facilities either on or off the employer's premises.
Categories: General Benefits

Chilling Effect: Maintenance by an employer of a work environment or a system of employment practices, the effect of which is to discourage Minorities, Women, Persons with Disabilities, and/or Vietnam Era Veterans from seeking employment or advancement within organization.
Categories: Diversity

Chilling Effect: Maintenance by an employer of a work environment or a system of employment practices, the effect of which is to discourage minorities, women or persons with disabilities from seeking employment or advancement.
Categories: Human Resource

CHIP (Children's Health Insurance Program): Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid, but not enough money to buy private insurance.
Categories: Health Insurance

Civil Rights: Rights protected by the U. S. Constitution and various statutes which prohibit discrimination in employment, education, housing, voting, public accommodations and other matters.
Categories: Human Resource

Civilian Labor Force: Persons 16 years of age or over, excluding those in the Armed Forces, who are employed or seeking employment.
Categories: Human Resource

Claim: A request for payment of a benefit by a plan participant or his or her health care provider to the insurer for items or services the participant believes are covered by the plan.
Categories: Health Insurance

Claim: A written request by the worker, or on the worker's behalf, for compensation.
Categories: Workers Compensation

Claim form: The form used to report a work injury or illness to the employer.
Categories: Workers Compensation

Claimant: A person who files a claim for occupational disease or injury benefits under workers' compensation law.
Categories: Workers Compensation

Claims administrator: The term for insurance companies or insurer representatives who process workers’ compensation claims filed by workers (also called claims examiner or claims adjuster).
Categories: Workers Compensation

Classified Service: All positions in the state service except those which are specifically placed in the unclassified service by K.S.A. 75-2935, as amended, or other sections of the statutes (K.A.R. 1-2-19).
Categories: Human Resource

Cliff vesting: No vesting occurs until an employee satisfies the service requirements for 100 percent vesting-for example, 5 years.
Categories: Retirement Benefits

COBRA (Consolidated Omnibus Budget Reconciliation Act): A federal law that may allow a plan participant or his or her dependents to temporarily keep their existing health coverage after certain qualifying events (such as the participant's employment ending or losing coverage as a dependent of a covered employee). Click here for more information.
Categories: Health Insurance

Code Set: This is any set of codes used to encode data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes. This includes both the codes and their descriptions.
Categories: HIPAA

Coinsurance:: The percentage of costs of a covered health care service the participant pays after having paid his or her deductible.
Categories: Health Insurance

Combined condition: Occurs when a pre-existing condition combines with a compensable condition. A combined condition may cause disability or prolong treatment.
Categories: Workers Compensation

Commercially insured: The employer pays monthly premiums to an insurance carrier in exchange for the carrier assuming all risks of underwriting a short-term disability policy. The actuarially determined premium is often specified as a rate per $10 of weekly benefit per month. In some cases, the employer contributes a specific amount (often, a number of cents per hour worked for each employee) to a designated union fund that provides welfare benefits.
Categories: Disability Benefits

Common stock fund: This is a professionally managed fund invested in the common stock of a variety of companies.
Categories: Retirement Benefits

Community Outreach: Activities designed to contact appropriate community groups and persons for the purpose of recruitment.
Categories: Human Resource

Commutation: An order by a workers' compensation judge for a lump sum payment of part or all of a permanent disability award.
Categories: Workers Compensation

Companion Guide: A document prepared by each payer to specify the conditional data elements and segments that must be used when conducting HIPAA-standard transactions with that payer organization. The guide also outlines connectivity requirements and other useful information to support implementation of the HIPAA standard transactions. The Companion Guide is designed to supplement, but not to contradict any of the requirements in the Implementation Guide.
Categories: HIPAA

Company stock: Employees receive equity in the company that sponsors the defined contribution plan.
Categories: Retirement Benefits

Compensable injury: An accidental injury to a person or prosthetic appliance, arising out of and in the course of employment that requires medical services or results in disability or death. A claim is compensable when it is accepted.
Categories: Workers Compensation

Compliance: The degree to which an employer carries out (complies with) the mandatory Affirmative Action Plan or non-discrimination clause in its contracts.
Categories: Diversity

Compliance: Adherence to laws, court decisions, regulations, executive orders and other legal mandates governing affirmative action and equal employment opportunity.
Categories: Human Resource

Compliance Date: This is the date by which a covered entity must comply with a standard, an implementation specification, or a modification. This is usually 24 months after the effective data of the associated final rule for most entities, but 36 months after the effective data for small health plans. For future changes in the standards, the compliance date would be at least 180 days after the effective data, but can be longer for small health plans and for complex changes.
Categories: HIPAA

Compliance Review: Routine review of the employment practices of an employer by an agency.
Categories: Diversity

Compromise and release (C&R): A settlement agreement between the parties to a workers’ compensation claim that resolves all or some of the issues in the case (also called claim disposition agreement or CDA).
Categories: Workers Compensation

Concentration: A higher representation of a group of persons in a job category that would reasonably be expected by their presence in the civilian labor force.
Categories: Human Resource

Conditions of Employment: This includes, but not limited to, salaries, wages, hours of work, vacation allowances, sick and injury leave, number of holidays, retirement benefits, insurance benefits, prepaid legal service benefits, wearing apparel, premium pay for overtime, shift differential pay, jury duty and grievance procedures.
Categories: Human Resource

Congenital Disability: Describes a disability that has existed since birth but is not necessarily hereditary.
Categories: Human Resource

Consent: Consent by the patient is required for use and disclosures of PHI used for TPO
Categories: HIPAA

Consequential condition: A condition arising after a compensable injury and for which the major contributing cause is the injury or treatment rendered that increases either disability or need for treatment.
Categories: Workers Compensation

Consolidated leave plans: These are plans that provide a single amount of time off for workers to use for any of a number of purposes, such as vacation, illness, or personal business.
Categories: Paid Leave

Constructive Discharge: An employee's involuntary resignation resulting from the employer making working conditions for the employee so intolerable that a reasonable person would have felt compelled to resign. An enforcement agency will assert that an employee was constructively discharged where it finds that 1.a reasonable person in the employee's position would have found the working conditions intolerable; 2.the employer's conduct which constituted the violation against the employee created the intolerable working conditions; and 3.the employee's involuntary resignation resulted from the intolerable working conditions.
Categories: Human Resource

Consulting physician: A physician who advises the attending physician or authorized nurse practitioner regarding the treatment of a worker's injury.
Categories: Workers Compensation

Contested-case hearing: A formal proceeding at which parties can present evidence in support of their case to an administrative law judge who issues an order resolving the dispute.
Categories: Workers Compensation

Co-op Plan: A health plan offered by a non-profit organization in which the same people who own the company are insured by the company.
Categories: Health Insurance

Copay (also known as copayment): A fixed amount the participant pays for a covered health care service after having paid his or her deductible.
Categories: Health Insurance

Cost Sharing: The share of costs covered by insurance that a plan participant pays out of his or her own pocket. Cost sharing generally includes deductibles, coinsurance, and copays, but does not include premiums.
Categories: Health Insurance

Covered Entity: A health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in connection with a HIPAA transaction.
Categories: HIPAA

Cumulative injury: An injury caused by repeated events or repeated exposures at work.
Categories: Workers Compensation

- D -

Data Condition: A description of the circumstances in which certain data is required.
Categories: HIPAA

Data Content: All the data elements and code sets inherent to a transaction, and not related to the format of the transaction.
Categories: HIPAA

Data Element: This is the smallest named unit of information in a transaction.
Categories: HIPAA

Data Format: Those data elements that provide or control the enveloping or hierarchical structure, or assist in identifying data content of, a transaction.
Categories: HIPAA

Date of injury: When the worker got hurt or ill. If the injury was caused by one event, the date it happened is the date of injury. If the injury or illness was caused by repeated exposures (a cumulative injury), the date of injury is the date the worker knew or should have known the injury was caused by work.
Categories: Workers Compensation

De facto denial: The failure of an insurer to accept or deny a claim within the statutory time frame.
Categories: Workers Compensation

Death benefits: Benefits paid to surviving dependents when a work injury or illness results in death.
Categories: Workers Compensation

Deductible: The amount a plan participant pays for covered health care services before his or her insurance plan starts to pay.
Categories: Health Insurance

Deferred claim: A claim not yet accepted or denied by the insurance company or self-insured employer.
Categories: Workers Compensation

Defined Benefit Plans: Defined benefit pension plans provide employees with guaranteed retirement benefits based on benefit formulas. A participant's retirement age, length of service, and preretirement earnings may affect the benefits received. Definitions, key provisions, and related terms follow.
Categories: Retirement Benefits

Defined contribution plans: Defined contribution plans are retirement plans that specify the level of employer contributions and place those contributions into individual employee accounts.
Categories: Retirement Benefits

De-Identification: Removal or coding of the listed 18 elements of PHI and other additional elements if there was reason to believe that the remaining information by itself or in combination with other available information can identify an individual.
Categories: HIPAA

Denied claim (denial): A written refusal by an insurer to accept compensability or responsibility for a worker's claim of injury.
Categories: Workers Compensation

Dental Coverage: Benefits that help pay for the cost of visits to a dentist.
Categories: Health Insurance

Department of Justice, Civil Rights Division, Office of the Americans with Disabilities Act (DOJ): The federal agency with overall responsibility for enforcement of the ADA, investigating complaints and providing technical assistance on the ADA.
Categories: Diversity

Dependent: A child or other individual for whom a parent, relative, or other person may claim a personal exemption that reduces their tax obligation.
Categories: Health Insurance

Dependent care reimbursement accounts: Also known as flexible spending accounts, dependent care reimbursement accounts can be part of a flexible benefit plan or stand alone. Employees participating in these accounts allocate a declared pretax amount, up to a set limit, for out-of-pocket qualified expenses, including childcare, elder care, or services to a disabled dependent. Any money not used by the end of the plan year is forfeited.
Categories: General Benefits

Descriptive Video Service: The enhancement of a television program or movie with audio descriptions of costumes, scene information and actions not already perceived by simply listening to the audio. Descriptions are done so that they do not interfere with the program itself. (see Separate Audio Program)
Categories: Diversity

Developmental Disability: Any mental and/or physical disability that has an onset before age 22 and may continue indefinitely.
Categories: Human Resource

Diagnostic Test: Test to figure out what the plan participant's health problem is. For example, an x-ray can be a diagnostic test to diagnose a broken bone.
Categories: Health Insurance

Direct Data Entry (DDE): This is the direct entry of data that is immediately transmitted into a health plan’s computer.
Categories: HIPAA

Direct Threat: A significant risk; a high probability of substantial harm to the health or safety of the employee or others.
Categories: Human Resource

Disability: A physical or mental impairment that substantially limits one or more of the major life activities. (ADA)
Categories: Diversity

Disability management: A process to prevent disability from occurring or to intervene early, following the start of a disability, to encourage and support continued employment. May involve a rehabilitation nurse along with the treating physician. The progress of medical treatment is typically reported to the insurance company.
Categories: Workers Compensation

Disability payment: The payment for disability resulting from an accident or disease from which a worker is not expected to recover. May be partial or total.
Categories: Workers Compensation

Disability retirement: Disability retirement is retirement resulting from a totally disabling injury or illness prior to eligibility for early or normal retirement. Plans providing disability retirement benefits may have a service requirement of 10 years or more. Benefits may be immediate or deferred.
Categories: Retirement Benefits

Disabled Veteran: A person entitled to compensation under laws administered by the Veterans Administration for disability, or a person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty.
Categories: Diversity

Disabling claim: An injury which causes the worker temporary disability, permanent disability, or death. A claim may also be classified as disabling if there is a reasonable expectation that permanent disability will result from the injury.
Categories: Workers Compensation

Disabling compensable injury: An on-the-job injury that entitles the worker to temporary, permanent partial, or total disability payments, or results in death benefits.
Categories: Workers Compensation

Disadvantaged: A descriptive term referring to those individuals whose access to the benefits of society is severely restricted.
Categories: Human Resource

Disclosure: Release or divulgence of information by an entity to persons or organizations outside of that entity.
Categories: HIPAA

Discrimination: Illegal treatment of a person or group (either intentional or unintentional) based on race, color, creed, religion, ancestry, national origin, age, disability, sex, marital status, or sexual preferences or political or union affiliation.
Categories: Diversity

Disparate Effect: The tendency for a test, job qualifications or other employment practice to screen out or otherwise limit the employment opportunities of a certain group at a greater rate than others. Also called "adverse effect" or adverse impact".
Categories: Human Resource

Disparate Treatment: Unequal treatment in employment opportunities because of one's race, color, religion, sex, age, ancestry, national origin, disability or veteran's status. Also called "differential treatment".
Categories: Human Resource

Dispute: A disagreement about the right to payments, services or other benefits.
Categories: Workers Compensation

Diversified investments: These are professionally managed funds that are invested in more than one type of equity or debt instrument.
Categories: Retirement Benefits

Diversity: The inclusion, integration, awareness and appreciation of various cultures within a workforce and the opportunity for the maximum utilization of individual members' talents, skills and perspectives with a view towards increasing the organization's productivity.
Categories: Diversity

Diversity Director: A highly placed individual within the Secretariat who has the authority and responsibility to implement the Secretariat's Affirmative Action/Equal Opportunity/Diversity Plans.
Categories: Diversity

Diversity Officer: A highly placed individual within the Agency who has the authority and responsibility to implement the Agency's Affirmative Action/Equal Opportunity/Diversity Plans.
Categories: Diversity

Dollar amount formulas: Benefits are based on a dollar amount per month for each year of service recognized by the plan.
Categories: Retirement Benefits

DSMO: Designated Standard Maintenance Organization
Categories: HIPAA

- E -

Early retirement: Early retirement is the age (or a combination of age and service) at which plan participants may retire and receive all accrued benefits, minus a reduction for the number of years by which their retirement age precedes their normal retirement age.
Categories: Retirement Benefits

EDI: Electronic Data Interchange - X12 and similar variable-length formats for the electronic exchange of structured data. It is sometimes used more broadly to mean any electronic exchange of formatted data.
Categories: HIPAA

EEO-1 Report: An annual report filed with the Joint Reporting Committee by certain employers subject to the Executive Order or to Title VII of the Civil Rights Act of 1964, as amended. This report details the sex and race/ethnic composition of an employer's workforce by job category.
Categories: Human Resource

EEO-2 Report: The Equal Employment Opportunity Apprenticeship Information Report: A chronological list of names of all persons who have applied to an apprenticeship program. The information needed to fill out the report must be kept by the apprenticeship sponsor; however, the EEOC no longer requires the filing of EEO-2 reports.
Categories: Human Resource

EEO-3 Report: The Equal Employment Opportunity Labor Union Report: A report filed by labor unions. This report is filed with the EEOC Survey Branch and contains information on the sex and race/ethnic composition of union membership and referrals for employment.
Categories: Human Resource

EEO-4 Category: Any of the categories designated by EEOC Form 164: A - Officials/Administrators B - Professionals C - Technicians D - Protective Services, Sworn E - Protective Services, Non-Sworn F - Administrative Support (including Clerical and Sales) G - Skilled Craft H - Service/Maintenance
Categories: Human Resource

EEO-4 Report: The Equal Employment Information Report (EEO-4): A report filed by state and local governments with the State and Local Reporting Committee. This report sets forth the sex and race/ethnic composition of the workforce by job category and annual salary. Frequency of reporting for political jurisdictions varies with their number of full-time employees.
Categories: Human Resource

EEO-5 Report: The Equal Employment Opportunity Elementary-Secondary Staff Information Report (EEO-5): A report filed with the School Reporting Committee. This report details the sex and race/ethnic composition, by job category, of elementary and secondary school staffs. Frequency of reporting for school districts varies with their number of pupils.
Categories: Human Resource

EEO-6 Report: The Equal Employment Opportunity Higher Education Staff Information Report (EEO-6): A report filed with the Higher Education Reporting Committee by colleges and universities. It details by job category and salary the sex and race/ethnic composition of their faculty and staffs.
Categories: Human Resource

Emergency Medical Condition: An illness, injury, symptom (including severe pain), or condition severe enough that a reasonable person would seek medical attention right away.
Categories: Health Insurance

Emergency Medical Transportation: Ambulance services for an emergency medical condition.
Categories: Health Insurance

Emergency Services: Services to check for or treat an emergency medical condition.
Categories: Health Insurance

Employed: Under criteria established by the Bureau of the Census and the U. S. Department of Commerce, all civilians 16 years old and who were either : (a) "at work", meaning those who did any work at all during the reference week as paid employees or in their business or profession, or on their farm, or who worked 15 hours or more as unpaid workers on a family farm or in a family business; or (b) "with a job but not at work," meaning those who did not work during the reference week but had jobs or businesses from which they were temporarily absent due to illness, bad weather, industrial dispute, vacation, or other personal reasons. Generally excluded from the category of employed are persons whose only activity consisted of unpaid work around the house or volunteer work for religious, charitable, and similar organizations, or person on layoff.
Categories: Human Resource

Employee: A person whose work activities are under the control of an individual or entity.
Categories: Workers Compensation

Employee assistance programs (EAPs).: A structured plan, closely related to employee wellness programs, that typically deals with more serious personal problems than the essentially medical problems covered by wellness programs. EAPs can offer referral services, or referral services in combination with counseling services. Both the referral services and the counseling services may be supplied by company personnel, by an outside organization under contract, or by a combination of both.
Categories: General Benefits

Employer: Any person or entity that contracts to pay for work or services, with the right to direct and control the work or services of any person.
Categories: Workers Compensation

Employer Mandate: Provision of the Affordable Care Act that requires certain employers with at least 50 full-time employees (including full-time equivalents) to offer health insurance coverage to their full-time employees (and their dependents) that meets certain affordability and minimum value standards, or pay a penalty tax. The employer mandate is often referred to as "pay or play." Click here for more information.
Categories: Health Insurance

Employer-at-injury: A worker's employer at the time the worker was injured.
Categories: Workers Compensation

Employment at Will: The traditional common law doctrine that, absent prior agreement to the contrary, an employer may discharge an employee anytime for any reason except for illegal reasons e.g., an employer's exercise of this power may be restricted by collective bargaining or other agreement or by specific statutes, including those prohibiting discrimination on the basis of race, sex or other factors. In some states, courts have imposed additional limits on employment at will by allowing claims for "wrongful discharge" in certain circumstances.
Categories: Human Resource

Equal Employment Opportunity: The right of all persons to work and to advance on the basis of merit and ability without regard to race, color, religion, sex, national origin, age, disability, veteran's status or other factors which cannot lawfully be the basis for employment actions.
Categories: Human Resource

Equal Employment Opportunity Commission (EEOC): Independent federal agency created by title VII of the Civil Rights Act of 1964. Responsible for administering Title VII, EEOC may bring suit, subpoena witnesses, issue guidelines which have the force of law, render decisions, provide technical assistance to complainants and others. The EEOC, which does not conduct routine compliance reviews, investigates complaints of discrimination in employment and finding probable cause attempts to achieve conciliation agreements and may bring a failed conciliation to court of law.
Categories: Diversity

Equal Employment Opportunity Commission (EEOC): The federal agency that enforces Title VII of the Civil Rights Act of 1964, as amended, and other federal civil rights laws.
Categories: Human Resource

Equal Opportunity: An organizations' effort to ensure that all personnel and service programs, policies and practices will be formulated and conducted in a manner which will ensure equal access for all people and prevent discrimination. As part of this effort organizations will ensure that employment and service provision policies will be based solely on the individual eligibility, merit or fitness of applicants, employees and recipients of services for jobs and services without regard to race, color, creed, religion, ancestry, national origin, age, disability, sex, marital status, affectional or sexual preferences or political or union affiliation.
Categories: Diversity

Ergonomics: The study of how to improve the fit between the physical demands of the workplace and the employees who perform the work. That means considering the variability in human capabilities when selecting, designing or modifying equipment, tools, work tasks and the work environment.
Categories: Workers Compensation

Essential Function: The fundamental job duties of a position that must be performed with or without an accommodation.
Categories: Human Resource

Essential functions: The primary job functions or tasks that an individual must be able to perform with or without a reasonable accommodation.
Categories: Workers Compensation

Essential Health Benefits: A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors' services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Click here for more information.
Categories: Health Insurance

Ex parte communication: Generally a private communication with a judge regarding a disputed matter without the other party being present or copied with correspondence.
Categories: Workers Compensation

Excluded Services: Health care services that a plan does not pay for or cover.
Categories: Health Insurance

Exclusive remedy: Basic concept that an employee injured on the job is entitled to workers' compensation benefits but may not sue the employer for damages. Workers' compensation is thus the exclusive remedy for a work-related injury.
Categories: Workers Compensation

Executive Order: A written instrument promulgated by the President of the United States or Governor of an individual state, which has the force of law.
Categories: Diversity

- F -

Facially Neutral Selection Standard/Criteria: A criterion/process is facially neutral if it does not make any reference to a prohibited factor and is equally applicable to everyone regardless of race, gender or ethnicity; i.e., is not discriminatory on its face.
Categories: Human Resource

Family and Medical Leave Act (FMLA): A federal law that provides certain employees with serious health problems or who need to care for a child or other family member with up to 12 weeks of unpaid, job-protected leave per year. It also requires that group health benefits be maintained during the leave.
Categories: Workers Compensation

Family leave: Family leave is granted to an employee to care for a family member and includes paid maternity and paternity leave. The leave may be available to care for a newborn child, an adopted child, a sick child, or a sick adult relative. Paid family leave is given in addition to any sick leave, vacation, personal leave, or short-term disability leave that is available to the employee.
Categories: Paid Leave

Federal Employer Identification Number (FEIN): A number assigned to a business by the Internal Revenue Service.
Categories: Workers Compensation

Filing: Sending or delivering a document to an employer or a government agency as part of a legal process.
Categories: Workers Compensation

Final order: An order, decision or award made by a workers' compensation judge that has not been appealed in a timely way.
Categories: Workers Compensation

Financial planning: A service to help employees make decisions related to savings, borrowing, investing, home purchases, education expenses, and retirement income.
Categories: General Benefits

Findings & award (F&A: A written decision by a workers' compensation administrative law judge about a case, including payments and future care that must be provided to the worker. The F&A generally becomes a final order unless appealed.
Categories: Workers Compensation

Fixed percentage of profits formula: This feature is common in deferred profit sharing plans. The employer contributes a fixed percentage of total annual profits to the plan. For example, no matter what the level of profits, 5 percent is contributed to the plan. Profits may include those for the entire company or just those in a specific business unit. In a variation of this formula, employers set aside a reserve amount of profits (for example, $1 million) and pay only a fixed percentage of any profits above this amount into the employees' defined contribution plan.
Categories: Retirement Benefits

Fixed-interest securities.: These securities include bonds and other non-Federal instruments that pay a fixed interest rate over a predetermined period.
Categories: Retirement Benefits

Flexible benefit plans: Also known as cafeteria benefit plans, flexible benefit plans are operated under provisions of Section 125 of the Internal Revenue Code. Section 125 allows employees to make a choice between cash (taxable) and noncash (nontaxable) benefits. The code permits companies providing flexible benefit plans to offer employees the following options: accident and health insurance plans, including health care spending accounts; group term life insurance and dependent coverage; disability benefits and accidental death and dismemberment plans; employee contributions to 401(k) plans or other thrift or savings plans (either pretax or after tax); dependent care assistance plans, including spending accounts; vacation days; and group legal services. Flexible benefit plans may be funded solely by the employer or through joint employer-employee contributions. Employers usually grant each employee credits to purchase benefits covered by the plan. Many plans include a core group of benefits (for example, life insurance coverage of $25,000) and allow employees to purchase additional levels of the core benefit as well as benefits not included in the core group. An example would be offering an additional $20,000 in life insurance coverage.
Categories: General Benefits

Flexible work schedule: Permits employees to set their own schedules within a general set of parameters. Employees generally are required to work a minimum number of core hours each day.
Categories: General Benefits

Flexible workplace: Permits workers to work an agreed-upon portion of their work schedule at home or some other approved location, such as a regional work center. Such arrangements are especially compatible with work requiring the use of computers linking the home or work center to the central office.
Categories: General Benefits

Formal Training: A structured program to develop an individual's job related skills and abilities. Typically classroom training as well as on-the-job training fall into this category.
Categories: Human Resource

Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. A formulary is often also called a drug list.
Categories: Health Insurance

Fraud: Any knowingly false or fraudulent statement for the purpose of obtaining or denying workers' compensation benefits. Each state has certain penalties for committing fraud including fines and/or imprisonment.
Categories: Workers Compensation

Fringe Benefits: Compensation for employment other than wages or salary, including, for example, annual and sick leave, medical insurance, life insurance, retirement benefits, profit sharing, bonus points, etc.
Categories: Human Resource

Front Pay: Compensation for estimated future economic loss; generally calculated based on the difference between the discrimination victim's current pay (or for a rejected applicant, the pay he/she should have received) and the pay associated with his/her rightful place. Front pay runs from the time of the settlement (e.g. Conciliation Agreement), hearing or administrative or court order to a certain time in the future set by the settlement, hearing or administrative or court order (usually when the victim attains his/her rightful place) set by the settlement, hearing or court order.
Categories: Human Resource

Frozen Retirement Pans: Frozen retirement plans are benefit plans that typically are closed to new enrollees and that may limit future benefit accruals for some or all active plan participants. These plans may be of different types. Some may no longer allow participants to accrue additional benefits. Others may change the plan's prospective benefit formula in such a way as to limit future benefit accruals. Other may use a prospective benefit formula to limit or cease accruals of benefits for some of the active participants.
Categories: Retirement Benefits

FTE (Full-time Equivalency): For affirmative action plan purposes, only positions occupied by an employee designated as "A" (active) in the SHARP system are used to calculate FTE. The percent of time worked is based on a standard of 100% or 1.0. For example, an employee who is working 60% and employee who is working 40% of the time would equal 100% or an FTE of 1.0.
Categories: Human Resource

Full-Time Position: Any employment position which requires 40 or more hours of work per week.
Categories: Human Resource

Fully Insured Plan: A health plan purchased by an employer from an insurance company.
Categories: Health Insurance

Funeral leave: Funeral leave provides time off from work because of a death in the family. The period of absence is usually limited to a few days (for example, 3 paid days for immediate family and 1 paid day for other relatives).
Categories: Paid Leave

Future medical: On-going right to medical treatment for a work-related injury.
Categories: Workers Compensation

- G -

General Education Development (GED): A certificate which is recognized by the State's Department of Education as being equivalent to a high school diploma.
Categories: Human Resource

Generic Drugs: A drug that has the same active-ingredient formula as a brand-name drug.
Categories: Health Insurance

Glass Ceiling: An artificial barrier to the advancement of women and minorities to decision-making positions.
Categories: Human Resource

Goal: Goals are objectives for hiring and promoting protected group members in EEO Categories to correct the lingering effects of past discrimination. Goals are flexible targets used to guide affirmative action efforts during the current plan cycle. Goals are not quotas and cannot be used to discriminate or exclude persons from employment opportunities through reverse discrimination.
Categories: Human Resource

Goals: A numerical objective, fixed realistically, in terms of the number of vacancies expected, and the number of qualified applicants available in the job market.
Categories: Diversity

Good Faith Efforts: A term used to describe documented, honest attempts to reach affirmative action goals.
Categories: Diversity

Governor's Trainee Program: A position established under the conditions of the Governor's Trainee Program (K.A.R. 1-6-31).
Categories: Human Resource

Graded vesting: An employee's nonforfeitable percentage of employer contributions increases over time, until vesting reaches 100 percent.
Categories: Retirement Benefits

Grandfathered Health Plan: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered health plans are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also provide consumers with contact information for questions or complaints.
Categories: Health Insurance

Group Health Plan: In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.
Categories: Health Insurance

- H -

Handicap: Describes a condition or barrier imposed by society, the environment or by oneself.
Categories: Human Resource

Harassment: Any repeated behavior, or combination of behaviors, by one or more employees toward another employee or group of employees based on race, color, national origin, religion, sex, disability, veterans status or age and which the affected employee considers to be annoying, insulting, intimidating which causes discomfort and/or which has a detrimental effect on such employees work performance.
Categories: Human Resource

Having a Record of Such an Impairment: Having a history of, or having been classified as having, a mental or physical impairment that substantially limits one or more major life activities.
Categories: Diversity

Health Care Clearinghouse: This is an entity that processes or facilitates the processing of information received from another entity in a nonstandard format or containing nonstandard data content into standard data elements or a standard transaction, or that receives a standard transaction from another entity and processes or facilitates the processing of that information into nonstandard format or nonstandard data content for a receiving entity.
Categories: HIPAA

Health Care Provider: An individual or facility that provides health care services. Examples include a doctor, nurse, chiropractor, physician assistant, hospital, surgical center, skilled nursing facility, and rehabilitation center.
Categories: Health Insurance

Health care reimbursement accounts: Also known as flexible spending accounts, health care reimbursement accounts can be part of a flexible benefit plan or stand alone. Employees participating in these accounts allocate a declared pretax amount, up to a set limit, for out-of-pocket health care expenses such as deductibles, copayments, coinsurance, and other qualified health care expenses not covered by their health insurance. Any money not used by the end of the plan year is forfeited.
Categories: General Benefits

Health Flexible Spending Arrangement (Health FSA): An arrangement an individual establishes through his or her employer to pay for out-of-pocket medical expenses with tax-free dollars. These expenses include insurance copays and deductibles, and qualified prescription drugs, insulin, and medical devices. Contributions to an FSA are subject to an annual limit that is adjusted for inflation each year. These arrangements are also referred to as Health Flexible Spending Accounts.
Categories: Health Insurance

Health Insurance: A contract that requires a health insurance company to pay some or all of a plan participant's health care costs in exchange for a premium.
Categories: Health Insurance

Health Insurance Marketplace: A service that helps people shop for and enroll in health insurance. The federal government operates the Marketplace, available at HealthCare.gov, for most states. Some states run their own Health Insurance Marketplaces.
Categories: Health Insurance

Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. There are generally two main types of HMOs:
Categories: Health Insurance

Health Plan: An individual or group plan that provides, or pays the cost of, medical care.
Categories: HIPAA

Health Reimbursement Arrangement (HRA: Employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts may be rolled over to be used in subsequent years. Also referred to as a Health Reimbursement Account.
Categories: Health Insurance

Health Savings Account (HSA): A type of savings account that allows an individual to set aside money on a pre-tax basis to pay for qualified medical expenses, if he or she has a high deductible health insurance plan. HSA contributions are subject to an annual limit that is adjusted for inflation each year.
Categories: Health Insurance

Health savings accounts (HSAs).: Portable accounts owned by employees and used to pay for medical expenses with tax-exempt contributions. HSAs are used in combination with employer-provided high-deductible health plans (HDHPs) with annual maximum limits on out-of-pocket and deductible expenses. Other features include the rollover of unused contributions from year to year and tax-free interest.
Categories: General Benefits

Hearing: A formal proceeding at which parties can present evidence in support of their case to an administrative law judge who issues an order resolving the dispute.
Categories: Workers Compensation

Hearing Disability: Hearing loss that prevents understanding of sound through the ear.
Categories: Human Resource

HHS (also DHHS): Department of Health and Human Services - The federal government department that has overall responsibility for implementing HIPAA.
Categories: HIPAA

High Deductible Health Plan (HDHP): A plan with a higher deductible than a traditional insurance plan. To be considered an HDHP, the plan must meet minimum deductible and maximum out-of-pocket limit requirements, which are annually adjusted for inflation.
Categories: Health Insurance

High-Risk Pool Plan: A state-subsidized health plan that provides coverage for individuals with expensive pre-existing health care conditions.
Categories: Health Insurance

HIPAA: A Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. Title II, Subtitle F, of HIPAA gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. Also known as the Kennedy-Kassebaum Bill, the Kassebaum-Kennedy Bill, K2, or Public Law 104-191.
Categories: HIPAA

HIPAA (Health Insurance Portability and Accountability Act): A federal law that ensures the privacy and security of protected health information and patients' access to their health-care records.
Categories: Workers Compensation

Hispanic: All persons of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
Categories: Human Resource

Hispanic (Latino/a): Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
Categories: Diversity

Holidays: Holidays are days off from work on days of special religious, cultural, social, or patriotic significance on which work and business ordinarily cease. Employees may receive either full or partial pay for holidays.
Categories: Paid Leave

Home Health Care: Health care services and supplies an individual receives in his or her home under doctor's orders. Services may be provided by nurses, therapists, social workers, or other licensed health care providers.
Categories: Health Insurance

Hospice Services: Services to provide comfort and support for persons in the last stages of a terminal illness.
Categories: Health Insurance

Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
Categories: Health Insurance

- I -

Immediate full vesting: Employees are immediately eligible to receive 100 percent of employer contributions.
Categories: Retirement Benefits

Immediate Labor Area: The geographic area from which employees reasonable may commute to the employer's establishment. It may include one or more contiguous cities, counties, Metropolitan Statistical Areas or parts thereof.
Categories: Human Resource

Impairment findings: A permanent loss of use or function of a body part or system as measured by a physician.
Categories: Workers Compensation

Implementation Guide (IG): A document explaining the proper use of a standard for a specific business purpose. The X12N HIPAA IGs are the primary reference documents used by those implementing the associated transactions, and are incorporated into the HIPAA regulations by reference.
Categories: HIPAA

In pro per: An injured worker not represented by an attorney.
Categories: Workers Compensation

Independent contractor: A person contracted to do work who is not subject to the direction and control of an employer. Unless independent contractors purchase workers' compensation insurance coverage for themselves, they generally cannot collect benefits for on-the-job injuries or illnesses. Labor law enforcement agencies and the courts look at several factors when deciding if someone is an employee or independent contractor.
Categories: Workers Compensation

Independent medical examination (IME): A medical examination of an injured worker by a physician other than the worker's attending physician performed at the request of the insurer. This includes physical capacity evaluations and work capacity evaluations, if requested by the insurer. The insurer or self-insured employer pays for this examination.
Categories: Workers Compensation

Individual Health Insurance Policy: Insurance policy for an individual who is not covered under an employer-sponsored plan.
Categories: Health Insurance

Individual Mandate: Provision of the Affordable Care Act that requires every individual to have minimum essential coverage for each month, qualify for an exemption, or make a penalty payment when filing his or her federal income tax return.
Categories: Health Insurance

Individual with a Disability: A person who has a physical or mental impairment that substantially limits one or more of her/his major life activities; is regarded as having such an impairment; or has a record of such an impairment.
Categories: Diversity

Individually Identifiable Health Information (IIHI): The subset of health information, including demographic information, collected from an individual on which there is a reasonable basis to believe that if the information can be used to identify the individual.
Categories: HIPAA

Injunctive Relief: A court order requiring a person to perform, or to refrain from performing, a designated act. For example, injunctive relief might be sought by requiring that the employer cease from asking discriminatory questions on its job application.
Categories: Human Resource

In-Network: Health care providers (e.g., specialists, hospitals, laboratories) that have accepted contracted rates with the insurer in order to participate in the insurer's network. The insured person typically pays a lower price for using services within the network.
Categories: Health Insurance

Inpatient Care: Health care that an individual receives when formally admitted as a patient to a health care facility, like a hospital or skilled nursing facility.
Categories: Health Insurance

Insured employer: An employer who has workers' compensation insurance to cover work injuries of subject workers.
Categories: Workers Compensation

Integration with Social Security: Defined benefit plans may integrate retirement benefits with Social Security benefits. Under this approach, the employer's contribution to Social Security (FICA taxes) is taken into account when plan benefits are computed. Integration may be accomplished by an offset or a step-rate method. .
Categories: Retirement Benefits

Internal Limit: Limitation that applies to individual categories of care—for example, a $250-per-procedure deductible for inpatient surgery.
Categories: Health Insurance

- J -

Job Analysis: A detailed analysis of the important functions of a particular job and the knowledge and skills necessary to successfully perform the functions.
Categories: Diversity

Job Area: Any subunit of a workforce sector, such as a department, job group, job title, etc.
Categories: Human Resource

Job Categories: The grouping of job titles by related responsibilities and functions:
Categories: Diversity

Job Description: A written statement detailing the duties of a particular job title.
Categories: Human Resource

Job Group: One or a group of jobs having similar content, wage rates and opportunities.
Categories: Human Resource

Joint-and-survivor annuity: The Employee Retirement Income Security Act of 1974 (ERISA) requires defined benefit pension plans that offer an annuity as a payment option to provide a qualified joint-and-survivor annuity (QJSA) as the normal benefit payment for married participants. A QJSA is an immediate annuity for the life of the participant and a survivor annuity for the life of the participant's spouse. The amount of the survivor annuity may not be less than 50 percent, or more than 100 percent, of the amount payable during the time the participant and spouse are both alive. The annuity payable for the life of the participant is lower than that for a straight life annuity; to account for the increased length of time over which payments will be made, this reduction may be a percentage of the straight life benefit, such as 10 percent, or may be based on the life expectancy of the participant and spouse.
Categories: Retirement Benefits

Jury duty: Jury duty leave provides a paid absence from work when one is summoned to serve as a juror. Employer payments commonly make up the difference between the employee's regular pay and the court's jury allowance.
Categories: Paid Leave

- L -

Labor Area: Geographic area used in calculating availability. The area may vary from local to nationwide.
Categories: Human Resource

Labor Force: As defined by the U.S. Bureau of Census: "All persons classified in the civilian labor force plus members of the Armed Forces."
Categories: Human Resource

Labor Market Area: The geographical area in which an employer can reasonably recruit persons for employment. The "labor market area" will generally be the SMSA for which census and other employment data is available.
Categories: Diversity

Large Print: Any print that is 14 point type or larger.
Categories: Diversity

Learning Disability: A permanent condition that affects the way individuals perceive, retain and express information.
Categories: Human Resource

Leisure leave: Access to one or more of the following benefits: paid vacation, paid holidays, and paid personal leave.
Categories: Paid Leave

Lien: A right or claim for payment against a workers' compensation case. A lien claimant, such as a medical provider, may follow specified procedure to request payment of money owed in a workers' compensation case.
Categories: Workers Compensation

Lifetime Limit: A cap on the total lifetime benefits a plan participant may receive from his or her insurance company. After a lifetime limit is reached, the insurance plan will no longer pay for covered services.
Categories: Health Insurance

Litigation: A legal process that usually results in a judge deciding the resolution of the dispute based on the facts and the law.
Categories: Workers Compensation

Long-term care insurance: A health plan that provides long-term (more than 1 year) custodial care, home care, or nursing home care. Coverage may be extended to active employees, retirees, parents of active employees, or dependents of active employees and retirees. Premiums are generally, though not necessarily, paid by employees. These plans are separate from coverage for extended care facilities or home health care found in health insurance plans that provide posthospitalization benefits for a limited period.
Categories: General Benefits

Long-term disability: Long-term disability (LTD) plans provide a monthly benefit to eligible employees who, because of a non-work-related illness or injury, are unable to work for an extended length of time. Benefits usually are paid as a fixed percentage of predisability earnings, up to a set limit. Most participants have a waiting period of 3 to 6 months, or until sick leave or STD benefits end, before LTD benefits begin. LTD benefits generally continue until retirement or a specified age, or for a period that varies with the employee's age at the time of the disability.
Categories: Disability Benefits

Lump sum: The payment of a permanent disability award in one check.
Categories: Workers Compensation

Lump-sum payment: The participant may opt for a full lump sum, with no further benefits received from the plan. If a plan provides for a partial lump-sum payment, the participant will receive a reduced annuity as well.
Categories: Retirement Benefits

- M -

Mail-order Drugs: Drugs that can be ordered through the mail.
Categories: Health Insurance

Major contributing cause (MCC): A cause deemed to have contributed more than 50 percent to an injured worker's disability or need for treatment.
Categories: Workers Compensation

Major Life Activities: Activities that an average person can perform with little or no difficulty. Examples are walking, speaking, breathing, performing manual tasks, seeing, hearing, learning, caring for oneself, working, sitting or standing.
Categories: Human Resource

Major Life Activity: One of many functions such as caring for one's self, performing manual tasks, walking, seeing, hearing, thinking, speaking, breathing, learning and working.
Categories: Diversity

Make Whole Relief: Remedies for discrimination that restore the victim of discrimination to his or her rightful place, i.e. the position, both economically and in terms of employment status, that he/she would have occupied had the discrimination never taken place. Common elements of make whole relief include an award of the position the individual was wrongfully denied, back pay with interest and retroactive seniority.
Categories: Human Resource

Managed care organization (MCO): An organization that contracts with an insurer to provide medical services to injured workers.
Categories: Workers Compensation

Mandatory Affirmative Action: Action taken by an employer on the basis of a self-analysis to investigate ten correct its employment practices in order to receive or qualify for a federal contract or grant. Also see: "Remedial and Voluntary Affirmation Action".
Categories: Human Resource

Mandatory settlement conference (MSC): A required conference to discuss settlement prior to a trial.
Categories: Workers Compensation

Maximum Medical Improvement (MMI): An assessed condition of a claimant based on medical judgment that the claimant has recovered from the work injury to the greatest extent that is expected and no further change in his/her condition is expected, with or without medical treatment. A finding of maximum medical improvement is a normal precondition for determining the permanent disability level of a claimant (also called medically stationary).
Categories: Workers Compensation

Mediation: The act of facilitating agreement and settling differences between disputing parties.
Categories: Workers Compensation

Medicaid: A joint state and federal insurance program that provides free or low-cost health coverage to some low-income people, families, children, pregnant women, the elderly, and people with disabilities.
Categories: Health Insurance

Medical Care: Services rendered by a hospital or qualified medical care provider.
Categories: Health Insurance

Medical Loss Ratio (MLR): A basic financial measurement used in the Affordable Care Act to encourage health plans to provide value to enrollees. If an insurer uses 80 cents out of every premium dollar to pay its customers' medical claims and activities that improve the quality of care, the company has a medical loss ratio of 80%. A medical loss ratio of 80% indicates that the insurer is using the remaining 20 cents of each premium dollar to pay overhead expenses, such as marketing, profits, salaries, administrative costs, and agent commissions. The Affordable Care Act sets minimum medical loss ratios for different markets, as do some state laws.
Categories: Health Insurance

Medical provider: A health care provider, hospital, medical clinic, or vendor of medical services.
Categories: Workers Compensation

Medical treatment: Treatment reasonably required to cure or relieve the effects of a work-related injury or illness (also called medical care).
Categories: Workers Compensation

Medical-legal report: A report written by a doctor that describes the worker’s medical condition. These reports are written to help clarify disputed medical issues.
Categories: Workers Compensation

Medicare: A federal health insurance program for people aged 65 and older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Medicare consists of four parts
Categories: Health Insurance

Medicare Part A:
Categories: Health Insurance

Medicare Part B: Covers medically necessary and preventive services.
Categories: Health Insurance

Medicare Part C (Medicare Advantage): A type of Medicare health plan offered by a private company that contracts with Medicare to provide the beneficiary with all of his or her Part A and Part B benefits.
Categories: Health Insurance

Medicare Part D: A program that helps pay for prescription drugs for people with Medicare who join a plan that includes Medicare prescription drug coverage. There are two ways to get Medicare prescription drug coverage: through a Medicare Prescription Drug Plan or a Medicare Advantage Plan that includes drug coverage, both of which are offered by insurance companies and other private companies approved by Medicare.
Categories: Health Insurance

Mental Disability: Any mental or psychological disorder, such as mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities.
Categories: Human Resource

Merit Principles: The basic tenets of public personnel administration, including such concepts as open competition for entry, selection on the basis of relative knowledge, skills and abilities, advancement based on relative performance and ability, and fair treatment of applicants and employees in all aspects of personnel administration without regard to race, color, religion, national origin, sex, ancestry, age disability or political affiliation.
Categories: Human Resource

Military leave: Military leave is paid absence from work to fulfill military commitments. Pay may be either regular pay or the difference between employees' regular earnings and the amount they receive from the military.
Categories: Paid Leave

Minimum Essential Coverage (MEC): Any insurance plan that meets the Affordable Care Act requirement for having health coverage (sometimes called qualifying health coverage). Individuals without minimum essential coverage may be subject to the individual mandate penalty.
Categories: Health Insurance

Minimum Necessary: The principle that, to the extent practical, individually identifiable health information should only be disclosed to the extent needed to support the purpose of the disclosure.
Categories: HIPAA

Minimum Value: A standard of minimum coverage that applies to employer-sponsored health plans. Click here for more information.
Categories: Health Insurance

Minority: Any individual from the following racial and/or ethnic groups
Categories: Diversity

Minority: For EEO official reporting purposes, the "minority" includes Blacks, Hispanics, Asian or Pacific Islanders and American Indians or Alaskan Natives.
Categories: Human Resource

Modified work: A modification to an injured worker's job duties or work schedule to accommodate the physical limitations resulting from the injury or disease.
Categories: Workers Compensation

Money market fund: This is a professionally managed mutual fund that invests in short-term Treasury bills, certificates of deposit, or corporate bonds. The fund managers sell shares to investors, who receive regular payments of interest.
Categories: Retirement Benefits

Multiple Function Covered Entity: A single legal entity, affiliated entity, or other arrangement which combines the functions or operations of health care providers, health plans and health care clearinghouses.
Categories: HIPAA

- N -

National Employer ID: A system for uniquely identifying all sponsors of health care benefits.
Categories: HIPAA

National Patient ID: A system for uniquely identifying all recipients of health care services. This is sometimes referred to as the National Individual Identifier (NII), or as the Health care ID.
Categories: HIPAA

National Payer ID: A system for uniquely identifying all organizations that pay for health care services. Also known as Health Plan ID, or Plan ID.
Categories: HIPAA

National Provider ID: A system for uniquely identifying all providers of health care services, supplies, and equipment.
Categories: HIPAA

National provider identifier (NPI): A unique identification number assigned to health care providers, individuals, groups, or organizations that provide medical or other health services or supplies.
Categories: Workers Compensation

Native American: Having origins in any of the original peoples of North America, and maintaining cultural identification through tribal affiliations or community recognition.
Categories: Diversity

Native Hawaiian or Other Pacific Islander: all persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. (The "Native Hawaiian" does not include individuals who are native to the State of Hawaii by virtue of being born there.) This group would also include the following Pacific Islander groups: Fijian, Kosraean, Melanesian, Micronesian, Northern Mariana Islander, Palauan, Papua, New Guinean, Ponapean, Polynesian, Solomon Islander, Tahitian, Tarawa Islander, Tokelauan, Tongan, Trukese, and Yapese.
Categories: Human Resource

Nepotism: The practice of showing favoritism to relatives or close friends of other employees over other applicants applying for positions.
Categories: Diversity

Network: The facilities, providers, and suppliers a health insurer or plan has contracted with to provide health care services.
Categories: Health Insurance

Noncommercially insured: The employer is required to have liquid assets corresponding to the projected liability of the plan. These plans must be registered with the Department of Labor and are guaranteed by ERISA. The employer assumes all risks and expenses of providing the benefit.
Categories: Disability Benefits

Nondisabling claim: A worker's compensation claim that does not result in time-loss or permanent disability, but requires only medical treatment (also called medical only).
Categories: Workers Compensation

Non-Exempt Employees: Employees that are covered by minimum wage and overtime provisions of the Fair Labor Standard Act (Wage and Hour Law).
Categories: Diversity

Normal Retirement: Normal retirement is the age at which plan participants may retire and receive all accrued benefits.
Categories: Retirement Benefits

Notice of Acceptance (NOA): A notice from the insurer or self-insured employer that informs the worker that the worker's claim has been accepted.
Categories: Workers Compensation

Notice of Compliance: A notice that must be posted in the employer's place of business, which shows the employer has complied with workers' compensation insurance coverage requirements.
Categories: Workers Compensation

Null Hypothesis (N/H): Based on the underlying assumption that employers are hiring or have selected persons from the population of available qualified persons on a random basis, such that each person is equally likely to be selected regardless of race, sex, or ethnic identification. Operating from this assumption of random selection, it is appropriate to hypothesize that for a specific race, sex, or ethnic group within a given occupation that the proportion of workers in an agency is equal to the proportion of workers in the relevant labor market for that occupation, such that any deviation may be attributed solely to chance. In the State Affirmative Action Plan Guide for Equal Employment Opportunity, a .o5 (20%) level of significance has been adopted. (Adverse impact is defined as occurring when the selection rate for a racial, sex, or ethnic group is less than four-fifths (80%) of the rate for the group with the highest selection ratio.) Thus, the null hypothesis is rejected if the probability of obtaining the observed difference, by chance, is more than 5% and an inference of underutilization is made.
Categories: Human Resource

- O -

Objective: A statement of a program goal which is to be accomplished through related action items.
Categories: Human Resource

Objective findings: The indications of injury or disease that are measurable, observable, and reproducible, used to establish compensability and determine permanent impairment (also called objective factors).
Categories: Workers Compensation

Occupational disease: A disease or infection, arising out of and occurring in the course and scope of employment which is caused by substances or activities to which an employee is not ordinarily subjected or exposed other than during employment and requires medical services or results in disability or death.
Categories: Workers Compensation

Occupational Safety and Health Administration (OSHA: The federal agency that oversees workplace safety and health in federal offices and in states without state OSHA programs.
Categories: Workers Compensation

Office and Clerical: Occupations in which workers are responsible for internal and external communication, recording data or information and other paperwork required in an office. Includes bookkeepers, messengers, clerk-typists, payroll clerk and kindred workers.
Categories: Diversity

Office for Civil Rights (OCR): The HHS entity responsible for enforcing the HIPAA privacy rules.
Categories: HIPAA

Office for Civil Rights,Department of Health and Human Services (HHS: Department of OCR with jurisdiction over any entity receiving federal assistance from HHS in enforcing regulations prohibiting discrimination because of sex, race, color, national origin (including persons with limited English proficiency), disability or religion. OCR enforces these regulations through complaint investigations, compliance reviews, pre-grant reviews and Voluntary Compliance outreach. OCR enforces prohibition of discrimination against persons with disabilities through section 504 of the Rehabilitation Act of 1973 and Title II of the ADA, Public Services, including all activities of state and local governments relating to health and human services.
Categories: Diversity

Office of Diversity and Equal Opportunity (ODEO): The regulatory agency responsible for the implementation of Affirmative Action within the Executive Branch of State Government. ODEO is responsible for statistical research to support the development and implementation of programs; the development and promulgation of Affirmative Action standards and guidelines; the enforcement of standards via uniform grievance procedure; and maintenance of all required reporting systems. ODEO provides regulatory and preventive functions to enforce state government compliance with Executive Order 478. The mission of ODEO addresses the following priorities: Extending the benefits of affirmative action to minorities, women, persons with disabilities, and certified Vietnam era veterans. Supporting agencies in the achievement in the workforce of parity for protected groups through aggressive goal setting and compliance with Affirmative Action Plans. Preventing averse impacts upon protected groups during reduction-in-force. Eliminating discriminatory practices and promotes Equal Employment for all employees of, or applicants for employment in, state government.
Categories: Diversity

Office of Diversity and Equal OpportunityWorkforce Region: An enumeration area designated by the Office of Diversity and Equal Opportunity for the purpose of defining parity.
Categories: Diversity

Official/Administrator: Occupations in which employees set policies, exercise responsibility for these policies, department heads, controllers or kindred workers.
Categories: Diversity

Officials/Administrators: An EEO-4 category that encompasses occupations in which employees set broad policies, exercise overall responsibility for execution of those policies or direct individual departments of special phases of the agency's operations, or provide specialized consultation on a regional, district or area basis.
Categories: Human Resource

Offset: Part of a participant's Social Security benefit is subtracted from the benefit otherwise payable by the plan. The maximum allowable offset is 83.3 percent of the Social Security benefit. The most common offset is 50 percent.
Categories: Retirement Benefits

Open Enrollment Period: The yearly period when people can enroll in a health insurance plan.
Categories: Health Insurance

Open-Access HMO: This type of HMO allows enrollees to receive services from an out-of-network provider at a higher cost than the enrollee would pay at an in-network provider. The additional costs may be in the form of higher deductibles, copays, or coinsurance.
Categories: Health Insurance

Open-Access HMO: A type of HMO that allows enrollees to receive services from an out-of-network provider at a higher cost than the enrollee would pay at an in-network provider. The additional costs may be in the form of higher deductibles, copays, or coinsurance.
Categories: Health Insurance

Opinion and order:: A formal decision issued by an administrative law judge at the Workers' Compensation Board that resolves a dispute.
Categories: Workers Compensation

Organizational Unit: (1) Any unit of the agency which is headed by an official who is under the direct supervision of the agency head; (2) units indicated in charts and documents filed with the Division of Budget or the Division of Personnel Services for layoff purposes, or (3) units which may be sub-divisions of larger organizational units headed by officials who are under the direct supervision of the agency head.
Categories: Human Resource

Out-of-Network: Services received outside an insurer's network. These services typically carry a higher cost to the insured person.
Categories: Health Insurance

Out-of-Pocket Costs: Expenses for medical care that are not reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and copays for covered services plus all costs for services that are not covered.
Categories: Health Insurance

Out-of-Pocket Limit: The most a plan participant can be required to pay for covered services in a plan year. The out-of-pocket limit does not include monthly premium amounts or spending for services the plan does not cover. An out-of-pocket limit is also called an "out-of-pocket maximum."
Categories: Health Insurance

Outpatient Care: Care received where a doctor has not written an order to admit the individual to a hospital as an inpatient (in these cases, an individual is an outpatient even if he or she spends the night in the hospital, but typically it does not require an overnight hospital stay).
Categories: Health Insurance

Overpayments: Money paid to an injured worker by the insurer that is more than is due the worker.
Categories: Workers Compensation

- P -

Palliative care: Medical services rendered to reduce or temporarily moderate the intensity of an otherwise stable condition to enable the worker to continue employment or training.
Categories: Workers Compensation

Para-Professional: Occupations in which workers perform some of the duties of a professional or technician in a supportive role, which usually require less formal training. Positions such as research assistants, medical aids, recreation assistants, home health aids and kindred workers.
Categories: Diversity

Parity: Equality. The ultimate goal of Affirmative Action programming by achieving the same level of representation internally as that achieved in the external workforce.
Categories: Diversity

Partial denial: Denial by the insurer of one or more conditions of a worker's claim, leaving some conditions of the claim accepted as compensable.
Categories: Workers Compensation

Party: Normally includes the insurance company, employer, attorneys and any other person with an interest in the worker’s compensation claim (such as doctors or hospitals that have not been paid).
Categories: Workers Compensation

Pattern or Practice Discrimination: Employer actions constituting a pattern of conduct resulting in discriminatory treatment toward the members of a class. Pattern or practice discrimination generally is demonstrated in large measure through statistical evidence, and can be proven under either the disparate treatment or disparate impact model.
Categories: Human Resource

Penalties: An action taken against a party for violations of workers' compensation laws or rules, such as monetary fines or suspension of benefits.
Categories: Workers Compensation

Pension equity plans: For each year of work, employees are credited with a percentage applied to their final average earnings. Benefits are generally disbursed as a lump sum
Categories: Retirement Benefits

Percentage of employee earnings: The employer contributes a fixed percentage of each employee's earnings to his or her individual account. This feature is common in money purchase plans.
Categories: Retirement Benefits

Percentage of unreduced accrued benefit: Under this method, the participant's pension is not reduced to adjust for survivor benefits. The participant will receive an amount equal to the straight life annuity, and the spouse will receive a proportion of that amount, often 50 percent, should the participant die.
Categories: Retirement Benefits

Percentage-of-contribution formulas: Benefits are based on employer and, occasionally, employee contributions. Benefits equal a percentage of total contributions.
Categories: Retirement Benefits

Permanent disability (PD): Any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached.
Categories: Workers Compensation

Permanent disability benefits: Payments received when a work injury permanently limits the kinds of work an individual can do or the ability to earn a living.
Categories: Workers Compensation

Permanent disability payments: Mandatory payments based on the undisputed portion of permanent disability received before and/or after an award is issued.
Categories: Workers Compensation

Permanent impairment: The permanent loss of use or function of a body part or system due to a compensable injury.
Categories: Workers Compensation

Permanent partial disability (PPD): The permanent loss of use or function of any portion of the body.
Categories: Workers Compensation

Permanent partial disability benefits: Payments received when a work injury partially limits the kinds of work an individual can do or the ability to earn a living.
Categories: Workers Compensation

Permanent total disability (PTD): The loss of use or function of any portion of the body, in combination with any pre-existing disability that permanently prevents the worker from regularly performing gainful and suitable work.
Categories: Workers Compensation

Permanent total disability benefits: Payments received when an individual is considered permanently unable to earn a living.
Categories: Workers Compensation

Personal leave: Personal leave is a general purpose leave benefit, used for reasons important to the individual employee, but not otherwise provided for by other forms of leave. Some employers place restrictions on the purposes for which personal leave may be used.
Categories: Paid Leave

Physical capacity evaluation (PCE): Measurements of a worker's ability to perform a variety of physical tasks.
Categories: Workers Compensation

Physical Disability: Any physiological disorder, or condition, cosmetic disfigurement, or anatomical loss affecting one or more of the following body systems: neurological, musculoskeletal, special sense organs, respiratory ( including speech organs), cardiovascular, reproductive, digestive, genitor-urinary, hemic and lymphatic, skin and endocrine.
Categories: Human Resource

Physical or Mental Impairment: A condition, such as contagious and non-contagious diseases and conditions such as orthopedic, visual speech and hearing impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes, mental retardation, emotional illness, learning disabilities, HIV disease, tuberculosis, drug addiction, alcoholism, that substantially limits one or more major life activities, such as thinking, walking, speaking, hearing, seeing, working, learning and breathing.
Categories: Diversity

Physician Services: Health care services a licensed medical physician provides or coordinates.
Categories: Health Insurance

Plan Sponsor: An entity that sponsors a health plan. This can be an employer, a union, or some other entity.
Categories: HIPAA

Plan types: Savings and thrift plans. Employees may contribute a predetermined portion of earnings (usually pretax)-all or part of which the employer matches-to an individual account. Employers may match a fixed percentage of employee contributions or a percentage that varies by length of service, the amount of employee contribution, or other factors. Contributions are invested as directed by the employee or employer. Although usually designed as a long-term savings vehicle, savings and thrift plans may allow withdrawals and loans before retirement. Deferred profit sharing plans. A defined contribution plan under which a company credits shares of company profits to participating employees' accounts. Plans may set a fixed formula for sharing profits, but are not required to do so. Profit sharing contributions to employees' accounts may be at the discretion of the company. Companies must set a method of allocating profit sharing contributions to individual employees. Common allocation methods include allocation proportional to employee salary and equal allocation to all employees. Contributions and any accrued investment earnings on the accounts normally are not distributed until an employee's retirement from the company. The plan may allow employee contributions, but employees seldom are required to contribute to the plan. Money purchase pension plans. Fixed employer contributions, typically calculated as a percentage of employee earnings, are allocated to individual employee accounts each year. Some plans may allow employee contributions, but employees usually are not required to make any contributions. Employers also may make profit-sharing contributions to these plans at their discretion. Employee stock ownership plans (ESOPs). The employer pays a designated amount, often borrowed, into a fund which then is invested primarily in company stock. Any debt incurred in the purchase of the stock is repaid by the company. Stock then is distributed to employees according to a formula. Individual retirement accounts (IRAs). An IRA is a retirement savings plan. There are several types of IRAs: Traditional IRAs, Roth IRAs, Simplified employee pensions (SEP) IRAs, and Savings-incentive match plans for employees (SIMPLE) IRAs. Traditional and Roth IRAs are established by individuals who are allowed to contribute earnings up to a set maximum dollar amount. SEPs and SIMPLE plans are retirement plans established by employers. Simplified employee pensions (SEPs). An individual retirement account (IRA) is established for each eligible employee. The employee is immediately vested in employer contributions and generally directs the investment of the money. These arrangements are sometimes called SEP-IRAs. Savings-incentive match plans for employees (SIMPLE plan). A plan limited to employers with fewer than 100 employees and who also do not have any other qualified retirement plan. SIMPLE plans can be either part of a 401(k) plan or established as IRAs. In addition, participants aged 50 years or older may make additional pretax employee contributions into a SIMPLE plan. Employers must either make matching contributions of up to 3 percent of compensation or make a 2-percent nonelective contribution to all eligible employees.
Categories: Retirement Benefits

Plan Year: A 12-month period of benefits coverage under a group health plan. This 12-month period need not align with the calendar year.
Categories: Health Insurance

Portability: Portability is a participant's ability to maintain and transfer accumulated pension benefits when changing jobs. Portability provisions in defined benefit plans generally cover portability of assets, portability of credited service, or both.
Categories: Retirement Benefits

Portability of assets: Participants can withdraw their accumulated pension benefits or transfer them to another retirement arrangement.
Categories: Retirement Benefits

Portability of credited service: Participants are allowed to count the years of service with a previous employer when determining benefits from their current employer.
Categories: Retirement Benefits

Position: A group of duties and responsibilities, assigned or delegated by an appointing authority, requiring the services of an employee on a full-time basis or, in some cases, on a less than full-time basis (K.A.R. 1-2-59).
Categories: Human Resource

Position Description: A description of the duties and responsibilities of a position, and the education, experience, knowledge, skills, and abilities necessary to perform the duties and responsibilities of the position in a satisfactory manner (K.A.R. 1-2-63). Preferential Treatment: More favorable treatment accorded to one group because of their race, color, religion, sex, age disability, national origin or other factor not related to job performance.
Categories: Human Resource

Position Review: The official study by the agency personnel officer or the Division of Personnel Services of the current or proposed duties and responsibilities of a position (K.A.R. 1-2-61).
Categories: Human Resource

Preauthorization: A decision by a health plan that a health care service or product is medically necessary. A health plan may require preauthorization for certain services before they are provided (except in an emergency), though preauthorization is not a promise by a health plan to cover the cost.
Categories: Health Insurance

Pre-Existing Condition: A health problem an individual had before the date that his or her new health coverage starts.
Categories: Health Insurance

Pre-Existing Condition Exclusion Period: The period during which an insurance policy will not pay for care relating to a pre-existing condition.
Categories: Health Insurance

Preferred Provider Organization (PPO): A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. Under a PPO, a plan participant pays less in out-of-pocket costs if he or she uses providers that belong to the PPO's network.
Categories: Health Insurance

Premium: The amount a plan participant pays for his or her health insurance every month.
Categories: Health Insurance

Premium: The amount of money an employer pays an insurance company for a workers' compensation policy.
Categories: Workers Compensation

Premium Tax Credit: A tax credit an individual can use to lower his or her premium when he or she enrolls in a plan through the Health Insurance Marketplace. The Premium Tax Credit is based on the income estimate and household information the individual provides on his or her Health Insurance Marketplace application.
Categories: Health Insurance

Preponderance of evidence: Evidence that is of greater weight or more convincing than evidence on the other side of the issue. In workers' compensation, the term is often used in relation to weighing medical opinion.
Categories: Workers Compensation

Prescription Drug Coverage: A health plan that helps pay for prescription drugs and medications.
Categories: Health Insurance

Prescription Drugs: Drugs and medications that, by law, require a prescription.
Categories: Health Insurance

Pretax savings with no employer contributions: These are cash or deferred arrangements used to fund savings and retirement plans authorized by section 401(k), 403(b), or 457 of the Internal Revenue Code. The employees' contributions reduce their salaries for tax purposes.
Categories: General Benefits

Preventive Services: Routine health care that includes screenings, check-ups, and patient counseling to prevent health problems.
Categories: Health Insurance

Prima Facie Case: Refers to the initial burden of the complainant to show actions taken by the employer are more likely than not to be discriminatory, if such actions remain unexplained.
Categories: Human Resource

Primary Care: Health services that cover a range of prevention, wellness, and treatment programs for common illnesses.
Categories: Health Insurance

Primary Care Provider: A physician, nurse practitioner, clinical nurse specialist, or physician assistant who provides, coordinates, or helps an individual access a range of primary care services.
Categories: Health Insurance

Primary Metropolitan Statistical Area (PMSA): An enumeration district designated by the Federal Office of Management and Budget (OMB) for statistical purposes.
Categories: Diversity

Pro se: A party that participates in a formal or informal dispute process without an attorney.
Categories: Workers Compensation

Probable Cause: A determination made by an enforcement agency, after an investigation of a charge of employment discrimination, that there is a basis "to believe that the charge is true." Also known as "reasonable cause".
Categories: Human Resource

Professional: Occupations requiring specific knowledge usually acquired through college training i.e. social workers, doctors, accountants, registered nurses, teachers and kindred workers.
Categories: Diversity

Professionals: An EEO-4 category that encompasses occupations which require specialized and theoretical knowledge usually acquired through college training or work experience and other training that provides comparable knowledge.
Categories: Human Resource

Program Accessibility: Operating programs and activities so, when viewed in their entirety, they are readily accessible to and usable by individuals with disabilities. No qualified individual with a disability may be excluded from participation in, or be denied the benefits of the service, programs or activities of the Provider because of an access barrier.
Categories: Diversity

Proof of service: A form used to show that documents have been sent to specific parties.
Categories: Workers Compensation

Prosthetic appliance: The artificial substitution for a missing body part, such as a limb or eye, or any device that augments or aids the performance of a natural function, such as a hearing aid or glasses.
Categories: Workers Compensation

Protected Class: Legally identified groups that are specifically protected by statute against discrimination. Protected class status is automatically conferred upon recognized minority group members, females, individuals with disabilities, etc., by the law. These are the same individuals who should be covered by the provider's Affirmative Action /Equal Opportunity and Programmatic Access Plan.
Categories: Diversity

Protected Group: Any legally recognized group that is specifically protected by statute from discrimination.
Categories: Human Resource

Protected Health Information (PHI): Individually identifiable health information that is transmitted or maintained in any form or medium.
Categories: HIPAA

Protective Service: An EEO-4 category that encompasses those occupations is which workers are entrusted with public safety, security and protection from destructive forces.
Categories: Human Resource

Protective Service (Sworn/Non-sworn): Occupations in which workers are entrusted with public safety or security, i.e., guards, firefighters, correctional officers, Life guards, Crossing guards, animal control workers and kindred workers.
Categories: Diversity

- Q -

Qualified Health Plan: An insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost sharing (like deductibles, copays, and out-of-pocket limits), and meets other requirements under the Affordable Care Act. All qualified health plans meet the minimum essential coverage requirement.
Categories: Health Insurance

Qualified Individual: A person who meets legal valid, predetermined and announced eligibility requirements. For example, a person with a disability who, with or without reasonable modifications to rules, policies, practices and or facilities, meets essential eligibility requirements shall be considered qualified.
Categories: Diversity

Qualified Individual with a Disability: A person with a disability who satisfies the requisite skill, experience, education and other job-related requirements of the employment position such individual holds or desires and who, with or without a reasonable accommodation, can perform the essential functions of the position.
Categories: Human Resource

Qualified Interpreter: An interpreter who is able to interpret effectively, accurately and impartially both receptively and expressively, using any necessary specialized vocabulary. (ADA)
Categories: Diversity

Quota: In employment law, court-ordered hiring and/or promoting of specific numbers or ratios of minorities or women in positions from which a court has found they have been excluded because of unlawful discrimination.
Categories: Human Resource

- R -

Race Code: A descriptive term used for reference when identifying a specific ethnic group: White, Black, Hispanic, Asian/Pacific Islander, American Indian/Alaskan Native.
Categories: Human Resource

Readily Accessible to and Usable by: When a program, service or activity is no harder to get to and used by an individual with a disability than it would be for anyone else.
Categories: Diversity

Readily Achievable: Easily accomplishable and able to be carried out without much difficulty or expense. (ADA)
Categories: Diversity

Reasonable Accommodation: The modification of environments, policies, programs, schedules, requirements and or facilities to adapt to the needs and abilities of an individual with disabilities, unless it would impose undue hardship. Reasonable accommodation may include building ramps, setting up TTY telephone lines, acquiring, providing auxiliary aids or services (like amplification equipment, sign language interpreters, qualified readers, a talking computer) or modifying existing equipment and providing job restructuring, modification of work schedules, reassignments of employees and/or clients.
Categories: Diversity

Reasonable Accommodation: Making existing facilities used by employee readily accessible to and usable by individuals with disabilities; and job restructuring; part-time or modified work schedules; reassignment to a vacant position; acquisition or modification of equipment or devices; appropriate adjustment or modifications of examinations, training materials or policies; provision of qualified readers or interpreters; and other similar accommodations for individuals with disabilities (K.S.A. 44- 1002(k)(1)(2).
Categories: Human Resource

Reconsideration: A legal process to appeal a decision issued by a workers' compensation judge.
Categories: Workers Compensation

Recruitment (or Relevant) Area: The geographic location(s) from which an agency or organization unit draws applicants for employment.
Categories: Human Resource

Referral: A written order from a primary care provider directing a patient to see a specialist or receive certain health care services. Under many health plans, a plan participant must obtain a referral before he or she can receive health care services from anyone except his or her primary care provider.
Categories: Health Insurance

Regarded as Having a Disability: If a person is treated as having a disability, or if a person has a physical or mental impairment that substantially limits major life activities only as a result of the attitudes of others towards such impairment then that person is considered to have a disability.
Categories: Diversity

Regular Position: Any position other than a temporary position (K.A.R. 1 -2-70).
Categories: Human Resource

Regular work: The job the worker held at the time of injury or a substantially similar job.
Categories: Workers Compensation

Rehabilitation Act of 1973: An act of Congress creating civil right protections for persons with disabilities in federal programs.
Categories: Diversity

Rehabilitation Services: Health care services that help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because he or she was sick, hurt, or disabled. These services may include physical and occupational therapy, speech therapy, and psychiatric rehabilitation services in a variety of inpatient and outpatient settings.
Categories: Health Insurance

Reinstatement: Rehiring a former permanent state employee within one year of a voluntary termination from the state into a position for which the individual meets the required selection criteria and which is in the same or similar class as the class in which the individual had permanent status prior to termination (K.A.R. 1-2-73).
Categories: Human Resource

Relay-System: A 1-800 telephone service offered by the New England Telephone Company that enables a hearing person to speak to a deaf/hard of hearing person without a TTY. (1-800-439-2370).
Categories: Diversity

Relevant Labor Market: Qualified persons in the recruitment area who are available for employment.
Categories: Human Resource

Remedial (Ordered) Affirmative Action: Corrective action(s) deemed necessary by a court or enforcement agency to correct or overcome the effects of past discrimination. What the corrective actions consist of depends largely on the circumstances of the employer, or the discretion of the court or enforcement agency. See also "Mandatory and Voluntary Affirmative Action".
Categories: Human Resource

Remedy: Whatever is required to "make the charging party whole," that is, whatever would have (or would not have) happened, had a violation not occurred, or, where that is not possible, money to compensate the charging party.
Categories: Diversity

Rescission: The retroactive cancellation of a health insurance policy. Insurance companies will sometimes retroactively cancel an entire individual health insurance policy if an individual made a mistake on his or her application for the policy that amounts to fraud or an intentional misrepresentation of material fact.
Categories: Health Insurance

Resignation: The voluntary termination of employment by an employee (K.A.R. 1-2- 78).
Categories: Human Resource

Retiree health care: A health plan that provides coverage to a retiree beyond what is mandated by COBRA or other health continuation laws. Coverage must include provisions typically found in a medical plan, such as hospitalization and doctor's care. The retiree plan does not have to be the same plan provided to active employees, nor does it matter whether the retiree pays the entire premium. Plans that cover only dental, vision, or prescription drugs are not included.
Categories: General Benefits

Role Based Access: Appropriate access for each person or class of person to the category or categories of protected health information to which access is needed.
Categories: HIPAA

- S -

Sanctions: An action taken against a party for violations of workers' compensation law or rules, such as monetary fines or suspension of benefits.
Categories: Workers Compensation

Screening: A type of preventive service that includes tests or exams to detect the presence of a health issue, usually performed when an individual has no symptoms, signs, or prevailing medical history of a disease or condition.
Categories: Health Insurance

Section 504 of the Rehabilitation Act of 1973: Section of the Act creating civil rights protections for persons with disabilities in programs receiving federal assistance.
Categories: Diversity

Security: Deposits, bonds, assignments, and certificates of title provided by self-insured employers to guarantee payment of compensation for injuries or other existing debts.
Categories: Workers Compensation

Selection Procedure: Any measure, combination of measures, or procedure used as a basis for any employment decision. Selection procedures include the full range of assessment techniques from traditional paper and pencil tests, performance tests, physical, education and work experience requirements through structured or unstructured interviews and unscored application forms.
Categories: Human Resource

Selection Procedures: Refers to the process for choosing the successful applicant for employment or advancement or for admission to a program.
Categories: Diversity

Selection Rate: The proportion of applicants or candidates who are hired, promoted or otherwise selected for a particular position.
Categories: Human Resource

Self-insured employer: An employer that directly assumes financial and processing responsibility for workers' compensation benefits rather than purchasing an insurance policy.
Categories: Workers Compensation

Self-Insured Plan: Type of plan usually present in larger companies, where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees' and dependents' medical claims. These employers often contract with a third-party administrator for services such as enrollment, claims processing, and provider networks.
Categories: Health Insurance

Separate Audio Program (SAP): A device built into televisions manufactured after 1987, which permits access to a separate audio track that includes descriptive narrative along with the program's original dialogue. Utilized by individuals who are blind or visually impaired. (see Descriptive Video System).
Categories: Diversity

Separation: Severance of an employment relationship. The action to separate from employment may be taken by the employee, the employer, or both.
Categories: Human Resource

Service company: A company contracted by a self-insured employer or insurer to administer its workers' compensation claims (also called a third-party administrator).
Categories: Workers Compensation

Service Maintenance: Occupations which result in or contribute to the comfort, convenience, hygiene or safety of the general public or which contributes to the upkeep and care of buildings, or grounds of public property includes chauffeurs, laundry operatives, custodial personnel and construction laborers.
Categories: Diversity

Service/Maintenance: An EEO-4 category that encompasses those occupations in which workers perform duties which result in or contribute to the comfort, convenience, hygiene or safety of the general public or which contribute to the upkeep and care of buildings, facilities or groups of public property. Workers in this group may operate machinery.
Categories: Human Resource

Settlement: An agreement between a worker and the insurance company about workers' compensation payments and future medical care.
Categories: Workers Compensation

Sexism: The belief in the superiority of one sex over the other based on the belief that gender is the determinant of human traits and capacities.
Categories: Diversity

Sexual Harassment: Sexual advances, requests for sexual favors, or verbal or physical conduct of a sexual nature which created a hostile, humiliating or offensive work environment, which materially interferes with the employee's ability to perform the job; submission to, or rejection of, sexual advances or requests for sexual favors which form the basis of an employment decision.
Categories: Diversity

Short-term disability: Short-term disability (STD) plans provide benefits for non-work-related illnesses or accidents on a per-disability basis, typically for a 6-month to 12-month period. Benefits are paid as a percentage of employee earnings or as a flat dollar amount. STD benefits vary with the amount of predisability earnings, length of service with the establishment, or length of disability.
Categories: Disability Benefits

Sick leave: Sick leave provides all or part of an employee's earnings if he or she is unable to work because of a non-work-related illness or injury. Employees commonly receive their regular pay for a specified number of days off per year. Sick leave is provided on a per-year basis, usually expressed in days, and is never insured.
Categories: Paid Leave

Signaler: A Signaling device equipped with a flashing light (Visual), an audio message (Audio), or movement (Motion) available with combined functions for fire, doorbell, and telephone. Could also include a bed shaker and strobe light for the bedroom or a strobe light only for the living room.
Categories: Diversity

Skill: A present, observable competence to perform a learned psychomotor act.
Categories: Human Resource

Skilled Craft: Occupations requiring special manual skill and a thorough and comprehensive knowledge of the processes involved in the work, acquired through apprenticeship or other formal training programs, mechanics and repairmen, electricians, carpenters, typesetters and kindred workers.
Categories: Diversity

Skilled Nursing Care: Services from licensed nurses in an individual's home or in a nursing home.
Categories: Health Insurance

Social Security disability benefits: Long-term financial assistance for totally disabled persons. These benefits come from the U.S. Social Security Administration and are generally reduced by workers' compensation payments the worker receives.
Categories: Workers Compensation

Social Security offset: A reduction of permanent total disability benefits based upon the amount of federal Social Security disability benefits received by a worker.
Categories: Workers Compensation

Special Enrollment Period (SEP): A time outside the yearly Open Enrollment Period when an individual can sign up for health insurance. An individual typically qualifies for a Special Enrollment Period as a result of certain life events, such as losing other health coverage, moving, getting married, having a baby, or adopting a child. By law, employer-sponsored health plans must provide a special enrollment period of at least 30 days.
Categories: Health Insurance

Specialist: A health care provider focusing on a specific area of medicine or group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.
Categories: Health Insurance

Specific injury: An injury caused by one event at work.
Categories: Workers Compensation

Specified matching percent: This feature is common in savings and thrift plans. The employer matches a specified percentage of employee contributions. The matching percentage can vary by length of service, amount of employee contribution, and other factors.
Categories: Retirement Benefits

Standard: Standard means a rule, condition, or requirement describing the information for products, systems, services or practices.
Categories: HIPAA

Standard Deviation: A statistical measure used to describe the probability that differences between similarly situated groups (such as in selection rates, wages, etc.) occurred by chance.
Categories: Human Resource

Standard Occupational Classification (SOC): This system provides a mechanism for cross-referencing and aggregating occupational-related data collected by social and economic statistical reporting programs. The classification covers all occupations in which work is performed for pay or profit and provides a coding system and nomenclature for identifying and classifying occupations. SOC classifications are the responsibility of the Office of Federal Statistical Policy and Standards.
Categories: Human Resource

State temporary disability plans.: The States of California, Rhode Island, Hawaii, New Jersey, and New York require temporary disability insurance (TDI) coverage. These plans provide temporary income for a limited period to workers who are unable to work because of non-work-related accidents or illnesses. California and Rhode Island mandated plans do not require employer contributions; Hawaii, New Jersey, and New York require employer contributions to disability plans.
Categories: Disability Benefits

Step rate: Lower benefit rates are applied to earnings up to the specified taxable Social Security wage base (that is, the earnings subject to Social Security tax); higher benefit rates are applied to earnings above the wage base.
Categories: Retirement Benefits

Stipulation: An agreement reached between an insurer and worker.
Categories: Workers Compensation

Stock bonus plan: Contributions are placed in a trust fund that invests in securities, including those of the employing company. This type of plan is financed by the employer or jointly by the employer and employee. Upon the employee's retirement or separation from the company, proceeds from the trust fund are paid out in the form of company stock or cash.
Categories: Retirement Benefits

Straight life annuity: A periodic payment made for the life of the retiree, with no additional payments to survivors.
Categories: Retirement Benefits

Subjective Criteria/Procedures: Employment qualifications, selection standards or processes that require judgment in their application, such that different persons applying such criteria/procedures would not necessarily reach the same conclusion. A criterion is subjective if it is not fixed or measurable.
Categories: Human Resource

Subjective factors: The amount of pain and other symptoms described by an injured worker that a doctor reports as contributing to a worker's permanent disability.
Categories: Workers Compensation

Subpoena: A document that requires a witness to appear at a hearing.
Categories: Workers Compensation

Subpoena Duces Tecum (SDT): A document that requires records be sent to the requester.
Categories: Workers Compensation

Substantially Limits: Unable to perform, or be significantly limited in the ability to perform, an activity compared to an average person in the general population.
Categories: Human Resource

Sub-Unit (As in the State Affirmative Action Plan): A group of organizational elements that together constitute an agency.
Categories: Human Resource

Summary of Benefits and Coverage (SBC): An easy-to-read summary that allows an individual to make apples-to-apples comparisons of costs and coverage between health plans. An individual most commonly receives an SBC when he or she shops for coverage or renews or changes coverage.
Categories: Health Insurance

Superimposed condition: A condition arising after and not related to the compensable injury that increases disability or need for treatment.
Categories: Workers Compensation

Supervisor: An employee who (a) performs some work which is different from that of the employee's subordinates; and (b) has the responsibility to authorize or recomment in the interest of the employer a majority of the following actions: 1.hire, transfer, suspend, promote, demote, dismiss, discipline other employees, and address employee grievances; and 2.assign, direct, and conduct performance reviews of the work. The exercise of this authority and responsibility shall not be of a merely routine or clerical nature but shall require the use of independent judgement.
Categories: Human Resource

Supplemental disability: Additional wage loss replacement due a worker employed in more than one job at the time of injury.
Categories: Workers Compensation

Suspension of benefits: An interruption of payment of benefits to an injured worker.
Categories: Workers Compensation

Systematic Discrimination: A pattern of discrimination that is the result of pervasive interrelated actions, policies and procedures.
Categories: Diversity

Systemic Discrimination: Employment policies or practices that serve to differentiate or to perpetuate a differentiation in terms or conditions of employment of applicants or employees because of their status as members of a particular group. Such policies or practices may or may not be facially neutral, and intent to discriminate may or may not be involved. Systemic discrimination, sometimes called class discrimination or a pattern or practice of discrimination, concerns a recurring practice or continuing policy rather than an isolated act of discrimination.
Categories: Human Resource

- T -

Tape: Print material read onto an audiocassette tape by sighted readers to be used by blind and visually impaired individuals who cannot access print.
Categories: Diversity

Targeted Recruiting: Any recruitment activity directed toward any person or group of persons based on race, color, religion, gender, national origin, or age that is not also equally and coincidentally directed toward all other persons.
Categories: Human Resource

Technician: Occupations requiring a combination of basic scientific or technical knowledge obtained through specialized post-secondary school education or on-the-job training such as computer operator or programmers, LPN's, medical or dental technicians, draftsmen and kindred workers.
Categories: Diversity

Technicians: An EEO-4 category that encompasses those occupations which require a combination of basic scientific or technical knowledge and manual skill which can be obtained through specialized post-secondary school education or equivalent on-the-job training.
Categories: Human Resource

Television Caption Decoder: A unit similar to a cable converter box, that is designed to decode a signal that allows captions that are easily visible - usually white letters against a black background - and appear at the bottom of television screens. TV screens. Note: All televisions 13" or larger manufactured on or after July 1, 1993 must include a computer chip that performs the same function as that of a decoder unit.
Categories: Diversity

Temporary Disabilities: Non-chronic disabilities of short duration that usually have little or no long-term impact. For example, broken limbs, sprains, concussions, appendicitis, common colds or influenza.
Categories: Human Resource

Temporary disability (TD or TTD): Payment for loss of wages because an injury prevents the worker from doing his or her usual job while recovering.
Categories: Workers Compensation

Temporary partial disability benefits (TPD): Payment for wages lost when a worker is only able to perform modified or part-time work because of a compensable injury.
Categories: Workers Compensation

Temporary Position: A classified position which is limited to not more than 999 hours of employment in a 12 month period. A temporary position shall not affect the position limitation of an agency.
Categories: Human Resource

Temporary total disability benefits (TTD): Payment for wages lost when a worker is unable to work because of a compensable injury.
Categories: Workers Compensation

Terminal-earnings formulas: Benefits are based on a percentage of average earnings during a specified number of years at the end of a worker's career (or when earnings are highest), multiplied by the number of years of service recognized by the plan.
Categories: Retirement Benefits

Test: any performance measure used as a basis for any employment decision.
Categories: Human Resource

Third Party Administrator (TPA): An entity that processes health care claims and performs related business functions for a health plan.
Categories: HIPAA

Timetable: The time frame set for attaining measurable Goals in an affirmative action program.
Categories: Diversity

Title VII: Normally refers to Title VII of the Civil Rights Act of 1964, as amended. Title VII generally prohibits discrimination in employment on the basis of race, color, religion, sex or national origin.
Categories: Human Resource

Trading Partner Agreement (TPA): An agreement related to the exchange of information in electronic transactions, whether the agreement is distinct or part of a larger agreement, between each party to the agreement. (For example, a trading partner agreement may specify, among other things, the duties and responsibilities of each party to the agreement in conducting a standard transaction.)
Categories: HIPAA

Traditional HMO: This type of HMO provides no benefits for services obtained outside of a network.
Categories: Health Insurance

Transactions: This is the exchange of information between two parties to carry out financial or administrative activities related to health care.
Categories: HIPAA

Transfer: A change by an employee from one position to another position with a close similarity of duties, essentially the same basic qualifications, and the same pay grade (K.A.R. 1-2-88).
Categories: Human Resource

Treatment, Payment & Operations (TPO): Treatment – the provision, coordination, or management of health care and related services by one or more health care providers. Payment – the activities undertaken by a health plan to obtain premiums or to determine or fulfill its responsibility for coverage and provision of benefits under the health plan; or the activities by a covered health plan or provider to obtain or provide reimbursement for the provision of health care included but not limited to: determination of eligibility, billing, claims management, collection activities, utilization review. Operations – the activities of the covered entity to the extent that the activities are related to covered functions; conducting quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, underwriting, compliance programming, business planning and management, customer service.
Categories: HIPAA

TRICARE: A health care program for active-duty and retired uniformed service members and their families.
Categories: Health Insurance

TTY: A telecommunication device for the deaf, consisting of a machine that employs graphic communication in the transmission of coded signals through a wire or radio communication system.
Categories: Diversity

- U -

Unclassified Service: Those positions specifically designated as unclassified by K.S.A. 75-2935, as amended, or other sections of the statutes (K.A.R. 1-2-97).
Categories: Human Resource

Underrepresentation (Or Underutilization): A lower representation of a group of persons in an occupational category's workforce than would reasonably be expected by their pressure in the relevant labor market.
Categories: Human Resource

Underutilization: Having fewer protected class members in a particular job classification would be expected by their availability in the workforce or recruitment area.
Categories: Diversity

Undue Financial or Administrative Burden: A defense available to a state or an entity operating a program, service or activity for that state which relieves it of responsibility for failure to provide access when the modification needed to provide access would fundamentally alter the program, service or activity inquisition or would be so costly that it would exceed its resources.
Categories: Diversity

Undue Hardship: Significant difficulty or expense when considering the nature and cost of the accommodation, the overall financial resources of the organization and the type of operations of the organization. (504).
Categories: Diversity

Unemployed: Under the criteria established by the Bureau of the Census of the U. S. Department of Commerce, civilians 16 years old or over are considered unemployed if they were: (a) neither "at work" nor " with a job" during the reference week; (b) looking for work during the last 4 weeks; and (c) available to accept a job. Also included as unemployed are persons who did not work at all during the reference week and were waiting to be called back to a job from which they had been laid off.
Categories: Human Resource

Unfunded salary continuation: The employer pays the benefit from operating revenue, assuming all associated risks and expenses.
Categories: Disability Benefits

Uniform Guidelines on Employee Selection Procedures: Guidelines adopted by federal agencies to provide a uniform set of principles governing use of employee selection procedures.
Categories: Human Resource

Uniformly Applied: Applying employment criteria/processes in the same manner to members of a particular race, color, religion, sex or national origin group and others.
Categories: Human Resource

Unlawful Employment Practice: Any policy analysis conducted by an employer to determine whether protected class members are employed in the major job categories.
Categories: Diversity

Unpaid family leave: This leave is granted to an employee to care for a family member. The leave may be used to care for a newborn child, an adopted child, a sick child, or a sick adult relative. A typical family leave plan extends leave without pay to an employee for a period of several months while the employee cares for the family member. The Family and Medical Leave Act (FMLA) of 1993 is a Federal law providing unpaid job-protected leave to eligible workers for the care of their families or themselves for specified family and medical conditions. The FMLA provides eligible workers with up to 12 workweeks of unpaid leave per year for the birth, adoption, or foster care placement of a child; care of a spouse, son, daughter, or parent with a serious health condition; or the employee's own serious health condition resulting in an inability to work. Employers with fewer than 50 employees at a worksite (and within 75 miles of that worksite) are excluded from FMLA.
Categories: Paid Leave

Unrelated condition: A medical or physiological problem not medically related to the injury.
Categories: Workers Compensation

Upward Mobility: A system for training, educating or otherwise preparing employees for more responsible, higher paying positions of employment.
Categories: Human Resource

Urgent Care: Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe that it requires emergency room care.
Categories: Health Insurance

Use: The sharing, employment, application, utilization, examination, or analysis of such information within the entity that maintains such information.
Categories: HIPAA

Usual, Customary, and Reasonable Charge (UCR): The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount is sometimes used to determine the allowed amount.
Categories: Health Insurance

Utilization Analysis: An analysis conducted by an employer to determine whether minorities, women and persons with disabilities are employed in each major job category at a rate comparable to the availability of qualified minorities, women or persons with disabilities in the relevant labor market for the positions covered by each job category.
Categories: Human Resource

- V -

Vacation: Vacations are leave from work (or pay in lieu of time off) provided on an annual basis and normally taken in blocks of days or weeks. Paid vacations commonly are granted to employees only after they meet specified service requirements. The amount of vacation leave received each year usually varies with length of service. Vacation time off normally is paid at full pay or partial pay, or it may be a percentage of employee earnings.
Categories: Paid Leave

Validation: The study of an employer's tests or selections standards, which proves that such tests or standards, is significant predictions of successful job performance. The study requires a large sample of applicants and must include representatives of groups suffering adversely from such standards.
Categories: Diversity

Validity: Correctness of a measure, i.e., that it does in fact measure what it purports to measure.
Categories: Human Resource

Vesting: Vesting refers to the amount of time a participant must work before earning a nonforfeitable right to a retirement benefit. Once the participant is vested, the accrued benefit is retained even if the worker leaves the employer before reaching retirement age. Under ERISA, defined contribution plans are subject to the same vesting rules as defined benefit plans, but vesting schedules vary. Vesting schedules apply only to employer contributions; employee contributions (including pretax contributions) are always 100 percent vested.
Categories: Retirement Benefits

Veteran of the Vietnam Era: A person who (a) served on active duty for more than 180 days, any part of which occurred between August 5, 1964 and May 7 1975 and was discharged or released therefrom with other than a dishonorable discharge; or (b) was discharged or released from active duty for a service-connected disability if any part of such active duty was performed between August 5, 1964 and May 7, 1975.
Categories: Human Resource

Vietnam Era Veteran: A person who served on active duty for a period of more than 90 days, any part of which occurred between August 5, 1964 and May 7, 1975, and was honorably discharged or released there from. Executive Order 478 defines Vietnam Era veterans and the State's commitment to a program to promote their welfare in this state.
Categories: Diversity

Vision Coverage: A health benefit that at least partially covers vision care, such as eye exams and glasses.
Categories: Health Insurance

Visual Disability: A condition in which a person has loss of vision for ordinary life purposes.
Categories: Human Resource

Vocational rehabilitation counselor: A certified vocational counselor hired by the insurer to provide vocational assistance to the injured worker.
Categories: Workers Compensation

Vocational Rehabilitation Organization (VRO): A business that provides, at an insurer's request, vocational assistance to injured workers.
Categories: Workers Compensation

Voluntary Affirmative Action: Actions taken by an employer on the basis of a self-analysis to investigate, then correct its employment practices or practices that appear to have had a disparate impact on the employment of protected group members.
Categories: Human Resource

- W -

Waiting Period: The time that must pass before coverage can become effective for an employee or dependent who is otherwise eligible for coverage under an employer-sponsored health plan.
Categories: Health Insurance

Well-Baby/Well-Child Care: Routine doctor visits for comprehensive preventive health services that occur when a child is 2 years of age and younger, and annual visits until a child reaches age 21. Services include physical exam and measurements, vision and hearing screening, and oral health risk assessments.
Categories: Health Insurance

Wellness programs: A structured plan, independent from health insurance, that offers employees two or more of the following benefits: smoking cessation programs, exercise/physical fitness programs, weight control programs, nutrition education, hypertension tests, periodic physical examinations, stress management programs, back care courses, and life style assessment tests.
Categories: General Benefits

White (Not of Hispanic Origins): All persons having origins in any of the original peoples of Europe, North Africa or the Middle East.
Categories: Human Resource

Withdrawals and loans: Withdrawals. Prior to normal payout (usually at retirement), defined contribution plan participants may be allowed to withdraw all or a portion of the employer funds from their accounts. Although most early withdrawals incur tax penalties, hardship withdrawals do not. To avoid tax penalties, many plans have loan provisions that allow employees to borrow from their accounts, with interest, for a specified period. Hardship withdrawals. Employees usually are not penalized when money is withdrawn as a result of a hardship, often defined as a death or illness of a family member, educational expenses, sudden uninsured losses, or a need to prevent eviction from one's primary residence. Loans. Defined contribution plans may allow participants to borrow employer funds, with interest, from their accounts. Loan amounts often are limited to a portion of the account balance. They usually have to be repaid within 5 years, but longer payment periods may apply for home purchase or renovation loans. Transfers or rollovers. A rollover is a direct payment of plan benefits from a defined contribution plan into an IRA or another employer's plan. In a direct rollover, the employee is not taxed on the payment until it is withdrawn or distributed later.
Categories: Retirement Benefits

Worforce Analysis: A detailed listing, by department or other organizational unit, of job classifications as they may appear in collective bargaining agreement or payroll records.
Categories: Diversity

Worforce Parity: The percentage of protected class members in the total labor force, regardless of occupational specialty.
Categories: Diversity

Work Behavior: Any activity performed to achieve the objectives of the job. Work behaviors involve observable (physical) components and unobservable (mental) components. A work behavior consists of the performance of one or more tasks. Knowledge, skills and abilities are not behaviors, although they may be applied to work behaviors.
Categories: Human Resource

Work capacity evaluation (WCE): A physical-capacity evaluation that focuses on the ability to perform work-related tasks.
Categories: Workers Compensation

Work Force: Employees, volunteers, trainees, and other persons under the direct control of a covered entity, whether or not they are paid by the covered entity.
Categories: HIPAA

Work restrictions: A doctor's description of the work an individual can and cannot do.
Categories: Workers Compensation

Worker: Any person who provides services for pay under the direction and control of an employer.
Categories: Workers Compensation

Workers' Compensation Board (WCB): Generally the state organization responsible for conducting hearings and reviewing legal decisions and agreements that affect injured workers' benefits.
Categories: Workers Compensation

Workforce: The total number of persons employed.
Categories: Diversity

Workforce Analysis: An analysis which reveals the composition of employees in a workforce by protected group status and occupational category.
Categories: Human Resource

Worksite modification: The changes made to an injured worker's job, tools, tasks, or worksite to accommodate the worker's injury-caused limitations.
Categories: Workers Compensation

- X -

X12 Standard: The term currently used for any X12 standard that has been approved since the most recent release of X12 American National Standards.
Categories: HIPAA