COMPLETE SOLUTIONS VERIFIED 2026/2027
Predictive Modeling A cost containment practice that analyzes
and Risk Assessment claims data and identifies high risk
potentially high cost members and
intervenes to avoid preventable cost
Performance A cost containment practice that collects
Measurement data after the fact via a provider
assessments, reports, and claims data
Cost containment that uses a manager to
Case Mangement coordinate members care in collaboration
with treating providers, facilities,
community resources and family members
to ensure the patient receives the right
level of care
Woman Cancer Act Law that requires health plans to provide
1998 mastectomy prosthetic devices and
reconstructive surgery coverage
Mental Health Parity Law requiring parity with respect to
and Addiction Equity aggregate lifetime and annual dollar
2008 limits for mental health benefits.
, ERISA Regulation that requires minimum standards of a
plan, providing information,
exercising fiduciary responsibilities in plan
admin and establishes appeal process
Welfare plans Another term for other employee benefits under
ERISA
Simple Cafeteria Plan Special plans allowed under ACA amendment to
Section 125 for eligible small
employers which are exempt from otherwise
applicable non discrimination testing
Contribution and A non discrimination test that examines
Benefits Test the level of non-taxable benefits for
highly compensated vs. Non HCE
Eligibility Test A non discrimination test that examines
whether the plan favors HCEs in
participation levels
HSA Employee owned trusts or custodial
accounts for reimbursement of medical
expenses that may be funded with EE or
ER contributions through a cafeteria plan
Non Elective Paid time off that is not subject to an election by
the employee
FSA Type of healthcare spending account that
requires forfeiture of any unused funds at
the end of the plan year