Glossary of Industry Terms

Component of consumer driven healthcare (CDH) that pairs a group health insurance plan with a tax-advantaged medical spending account such as an FSA, HRA, or HSA.

The ability to automatically verify that a purchase was made for an eligible medical expense (as defined by the IRS) with an FSA or HRA debit card at a merchant’s point-of-sale terminal. Merchants must have an IIAS system in place for auto-substantiation to take place.

The process of linking benefit accounts to a debit card, with features such as automatic adjudication and substantiation.

The process of establishing, maintaining, and managing benefits such as medical insurance, pension plans, consumer driven healthcare accounts, vacation time, etc., for the employees of an organization. Benefits administration is often done with in-house software or through a platform service subscription.

Employee benefit plan that allows employees to choose from two or more benefits, such as an FSA, HSA, Dependent Care, etc., as defined by Section 125 of the Internal Revenue Code.

An administrative solution that is centrally hosted on a server, with subscribers accessing the software through a network or internet connection.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) passed by the US Congress in 1985. COBRA provides workers and their families the right to continue group health benefits for a limited period of time after the worker experiences a life-changing event such as losing a job, transitioning between jobs, death, or divorce. Employers with 20 or more workers are required to offer COBRA, however, the worker pays for the continuing coverage. Learn more about COBRA.

A tax-advantaged benefits account used to pay for daily commuting expenses to and from work, such as bus, train, or subway fare. May also be referred to as a Commuter Benefit Account, Transit Account or Qualified Transportation Account.

A healthcare insurance plan that enables consumers to use FSAs, HRAs, HSAs, or similar accounts in order to pay for personal medical expenses. It is ‘consumer driven’ because it allows the individual to have more control over his or her personal healthcare as opposed to a fixed health insurance benefit. May also be referred to as Consumer Driven Healthcare (CDH) or Consumer-Directed Health Plan (CDHP).

Employer-sponsored healthcare plan where the benefit (i.e., physician visits, pharmacy) is clearly defined but the cost may vary year to year.

Employer-sponsored plan where the employer provides a defined contribution amount that allows employees to choose how the funds are spent on their healthcare. Component of consumer driven healthcare.

An electronic chip on credit and debit cards that is designed to increase card security and reduce fraud when using the card at a point of service terminal. EMV stands for Europay, MasterCard, and Visa. Learn more about EMV.

When a single vendor controls the entire chain of card processing including card creation and issuance, funding, payment transactions, technical support, and customer service.

A detailed statement sent by a health insurance company to a covered individual explaining what treatments and/or services were paid for on his or her behalf after a claim is filed due to the individual visiting a doctor or medical facility. The healthcare provider will also receive an EOB listing the services for which he or she is being paid, and the EOB may be sent with a check or electronic payment.

Tax-advantaged benefit account used to pay for eligible medical and childcare expenses. Employees fund their FSA by contributing part of their earnings tax-free. FSA is part of an employer-sponsored cafeteria plan. May also be referred to as a Flexible Spending Arrangement.

An extended period of coverage after the close of the plan year that allows account holders to use any leftover funds from their FSAs. Grace period typically extends to 2½ months after the end of the plan year.

Extra benefits that supplement an employee’s salary, such as health insurance, HSA contributions, and paid vacation time.

Tax-advantaged healthcare benefit that is employer-funded and -owned. Employees are reimbursed tax-free for qualified health expenses, as defined by the employer. May also be referred to as a Health Reimbursement Account.

Tax-advantaged health benefit plan that is employer-funded and reimburses employees for health insurance premiums.

Tax-advantaged account in which money can be set aside for health expenses. HSAs may be offered by employers or may be set up by the individual who purchases health insurance. The account owner must be enrolled in a qualified high deductible health plan (HDHP). Account owners maintain control of the HSA, even if the employer is making contributions. Learn more about HSAs.

Health plan with a lower premium and higher deductible than traditional health plans. Having coverage through a HDHP is a requirement for an HSA.

In the healthcare industry, indemnity payments are those payments made to an injured or sick worker whose injury or illness is directly correlated to his or her work. Indemnity payments serve as compensation to the employee for lost wages.

System that requires a merchant’s inventory and point-of-sale systems to have the ability to verify that the product being purchased with a FSA or HRA card is an eligible medical expense.

As part of a workers’ compensation claim settlement, funds may be set aside in an account to pay for future healthcare needs that are related to the injury, illness, or disease. May also be referred to as a Medicare Set Aside Account.

A type of Health Reimbursement Arrangement (HRA) that enables employers to fund parts of their employees’ health plan deductibles, co-insurance, or copayments, and pay for other qualified medical expenses, tax free.

The yearly period when people can enroll in or drop their health insurance plan, or make changes to their coverage.

DataPath’s card and virtual payment products for services related to indemnity payments such as Workers’ Comp and medical services, or other service related industries.

Under Section 223 of the IRS regulations, an individual with an HSA is only allowed to have certain other insurance coverage at the same time, referred to as ‘permitted coverage.’ Examples include insurance coverage for accidents, disability, dental care, vision, or long-term care.

Payment made to a service provider by means of virtual payment or check for services performed.

A tax-advantaged benefits account used to pay for daily commuting expenses to and from work, such as bus, train, or subway fare. May also be referred to as a Commuter Account, Commuter Benefit Account, or Transit Account.

When an employee retires and elects to continue receiving healthcare coverage under the company or union plan, and is invoiced rather than having a payroll deduction.

Refers to Section 105 of the IRS regulations that allow for tax-free reimbursement of medical expenses through an employer-sponsored health plan. This includes FSA, HRA, HSA, and MERP.

Refers to Section 125 of the IRS regulations that allow for pre-tax benefits through an employer such as accident and health benefits, adoption assistance, dependent care assistance, group term life insurance, and FSAs. Also referred to as a cafeteria plan.

Refers to Section 132 of the IRS regulations that allow for fringe benefits such as Commuter benefits, employee discounts, and retirement planning services.

Refers to Section 223 of the IRS regulations that govern Health Savings Accounts (HSA).

A software distribution model where the vendor hosts the applications on a server and subscribers access the application through a network or internet connection. It is part of ‘cloud computing.’

A state-based requirement similar to COBRA that applies to group health insurance policies for companies with fewer than 20 employees.

A person or organization that processes claims and performs other administrative services regarding employee benefits for their clients.

A person or other entity that provides reimbursement to healthcare providers for services rendered to a third party patient.

A tax-advantaged benefits account used to pay for daily commuting expenses to and from work, such as bus, train, or subway fare. May also be referred to as a Commuter Benefit Account or Commuter Account.

Paperless payment made to an individual or company. The payment recipient enters a unique, single-use code with payment information into their point-of-service terminal and the payment is delivered to the registered bank account.

A form of trust fund that is a tax-free health reimbursement account for post-retirement eligible medical expenses for retirees and eligible dependents. Accounts are funded through the monetary value of unused sick leave an employee has at the time of retirement.

Type of insurance that offers compensation to an employee who gets sick or injured as a direct result of their work. Should the employee accept workers’ compensation, he or she cannot sue the employer. Also referred to as Workers’ Comp.