Quick answers: From what a deductible actually means to how long you can stay on a parent's health plan (until age 26), most benefits confusion comes down to a small set of recurring questions. We pulled together the 32 we hear most often, grouped by topic, with straight answers.
Health insurance basics
1. What is a premium? The amount you (and often your employer) pay, usually monthly, just to have health insurance, regardless of whether you use it.
2. What is a deductible? The amount you pay out of pocket for covered services before your insurance starts paying its share.
3. What's the difference between a copay and coinsurance? A copay is a fixed dollar amount you pay per visit or service (like $30 for a doctor visit). Coinsurance is a percentage of the cost you pay after meeting your deductible (like 20% of a procedure's cost).
4. What is an out-of-pocket maximum? The most you'll pay in a plan year for covered services. Once you hit it, your insurance covers 100% of covered costs for the rest of the year.
5. What's the difference between a PPO and an HMO? A PPO gives you more flexibility to see out-of-network providers without a referral, usually at a higher cost. An HMO generally requires you to use in-network providers and get referrals for specialists, usually at a lower cost.
6. What is a formulary? The list of prescription drugs your health plan covers, usually organized into tiers that affect what you pay.
7. What does "in-network" vs "out-of-network" mean? In-network providers have a negotiated rate with your insurance, meaning lower costs for you. Out-of-network providers haven't agreed to those rates, so you typically pay more, sometimes the full cost.
8. What is open enrollment? The annual window when employees can enroll in, drop, or change their benefits without needing a qualifying life event.
Enrollment and eligibility
9. Can I change my benefits outside of open enrollment? Generally only if you experience a qualifying life event, like marriage, divorce, birth of a child, or loss of other coverage.
10. What counts as a qualifying life event? Common examples include marriage, divorce, birth or adoption of a child, loss of other health coverage, and a significant change in employment status.
11. When does my health insurance start as a new employee? This varies by employer, but many plans have a waiting period, commonly 30 to 90 days, before coverage begins.
12. Can I add my spouse or dependents to my plan? Yes, typically during open enrollment or within a set window after a qualifying life event like marriage or the birth of a child.
13. Until what age can my child stay on my health insurance? Under the Affordable Care Act, dependents can generally stay on a parent's health plan until age 26, regardless of student, marital, or financial dependent status.
14. What happens to my benefits if I go on leave? This depends on the type of leave and your employer's policy, but many employers continue health coverage during FMLA leave, with the employee still responsible for their normal contribution.
Tax-advantaged accounts
15. What's the difference between an HSA and an FSA? An HSA is owned by you, requires a high-deductible health plan, and rolls over indefinitely. An FSA is owned by your employer's plan, doesn't require an HDHP, and generally has limited rollover.
16. Can I have both an HSA and an FSA? Generally no, with one exception: a Limited Purpose FSA covering only dental and vision can be paired with an HSA.
17. What happens to unused FSA money at the end of the year? It's typically forfeited unless your employer offers a carryover (up to $680 for 2026) or a grace period.
18. What happens to unused HSA money at the end of the year? Nothing, it rolls over indefinitely and stays with you even if you change jobs or health plans.
19. What is an HRA? An employer-funded account that reimburses employees tax-free for qualified medical expenses, distinct from an HSA or FSA since only the employer contributes.
20. What is COBRA? A federal law letting you keep your employer's health plan for a limited time (typically 18-36 months) after a qualifying event like job loss, at your own full expense.
Leave and disability
21. What is short-term disability insurance? Coverage that replaces a portion of your income if you're unable to work due to a non-work-related illness or injury, typically for a period of weeks up to about a year, depending on the plan.
22. What is long-term disability insurance? Coverage that replaces a portion of your income for an extended period, sometimes until retirement age, if you become unable to work due to a qualifying illness or injury.
23. What is FMLA? The Family and Medical Leave Act, a federal law guaranteeing eligible employees at companies with 50+ employees up to 12 weeks of unpaid, job-protected leave for qualifying family or medical reasons.
24. What is paid family leave? State-specific programs (not a federal requirement) that provide partial wage replacement during leave for bonding with a new child, caring for a family member, or a personal medical condition, depending on the state.
25. How much PTO am I entitled to? There's no federal PTO requirement. Amounts vary entirely by employer policy and, in some cases, by state or local paid sick leave laws.
26. What is an EAP (Employee Assistance Program)? A free, confidential benefit many employers offer that provides short-term counseling, referrals, and support for mental health, financial, legal, or family issues.
Retirement and other benefits
27. What is a 401(k) match? When an employer contributes additional money to your 401(k) based on how much you contribute, commonly structured as a percentage match up to a certain amount of your salary.
28. What does it mean to be "vested" in my 401(k)? Vesting refers to how much of your employer's contributions you actually own. You're always 100% vested in your own contributions, but employer contributions often vest gradually over a set number of years.
29. What is employer-provided life insurance? A life insurance benefit, often provided at no cost up to a set amount (commonly 1-2x salary), that pays a death benefit to your designated beneficiaries.
30. What is voluntary or supplemental insurance? Additional coverage, like accident, critical illness, or extra life insurance, that employees can opt into and typically pay for themselves, often at a group rate through their employer.
31. What is a wellness stipend? A set amount of money an employer provides for wellness-related expenses, like a gym membership or fitness equipment, separate from formal health insurance.
32. What happens to my life insurance if I leave my job? Employer-provided life insurance typically ends when employment ends, though many plans offer the option to convert or port the coverage to an individual policy, usually at a higher cost.
About Bennie
Bennie is a modern employee benefits firm dedicated to transforming how employers design, manage, and deliver benefits. By combining world-class brokerage services with user-friendly technology, Bennie helps organizations lower costs and streamline administration while giving employees a centralized platform to navigate their healthcare. Headquartered in New York City, Bennie is licensed in all 50 states.
