Common Benefit Terms

Actively Employed (or actively-at-work)

You are currently performing work duties for your employer on a regular, full-time basis at the employer’s usual place of business or another location defined by them as a place of business. If you will not be actively employee starting [plan start date], please notify your FFGA representative.

Open Enrollment

The period of time when eligible employees have the opportunity to enroll in or change their current benefit elections.

Annual Deductible

The amount you must pay out-of-pocket every plan year before insurance will start paying for covered expenses.

Calendar Year

The calendar year begins January 1 and ends December 31.


The percentage or costs of a covered health care service you pay after you’ve paid your deductible; the insurance company pays the rest.

Guaranteed Issue

This is when carriers allow eligible employees to apply for coverage without answering medical questions or taking a health exam. It is usually only available during the initial eligibility period and/or for new hires, plus pre-existing condition and active employment provisions will apply as outlined in the plan.


A list of doctors, hospitals, dentists, and other providers who are contracted as a network provider within your plan.

Out-of-Pocket Maximum

The limit the insured can pay in co-insurance for covered expenses.

Plan Year

Your plan year begins Sept. 1 and ends Aug. 31, during which your benefits are in force.

Pre-Existing Conditions

This includes any medical issue, such as an illness, injury or disease, for which you take prescription drugs and/or receive medical care (including diagnostic and consultation services).

Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or receive medical care or services (including diagnostic and/or consultation services).