Every term that shows up in a broker's day.

A standardized plain-language summary of what a health plan covers and what it costs. Federal law requires every health plan in the U.S. (group, individual, marketplace) to provide an SBC in a uniform 4–8 page format with the same line items, in the same order, so plans can be compared apples-to-apples.

For brokers: The SBC is the document brokers spend the most time transcribing. Velora's SBC parser pulls the 22 plan-design fields (deductibles, copays, coinsurance, OOP max, Rx tiers) directly from the PDF, with per-field source-page references for verification.

Authority: 29 CFR § 2590.715-2715 ↗

The detailed legal document that describes how a self-funded ERISA health plan operates — eligibility, contributions, claims procedures, appeals, fiduciary roles. Must be furnished to plan participants within 90 days of enrollment.

For brokers: The SPD is the source-of-truth for plan rules; the SBC is the marketing-friendly summary. Where they conflict, the SPD wins legally.

Authority: 29 USC § 1024(b) ↗

A document an employer (or their broker) sends to carriers asking for medical / dental / vision / ancillary plan quotes for a renewal cycle. Includes census, claims experience, current rates, and required plan-design parameters.

For brokers: The benefits RFP is a different beast from the procurement-software RFP. Broker RFPs are 80%+ standardized fields plus a few free-text questions. Velora's RFP-response builder drafts the answers in your agency's voice using your book-of-business credibility data.

The dollar amount a plan member pays out-of-pocket each year before the plan starts paying for covered services. Embedded vs. aggregate matters for family coverage — embedded means each family member has their own deductible; aggregate means the whole family shares one.

The most a plan member can pay out-of-pocket for covered services in a plan year. Once hit, the plan pays 100% of covered costs. ACA caps the OOP max ($9,450 single / $18,900 family for 2024 plans).

A percentage split between plan and member after the deductible is met. A typical PPO might be 80/20 — plan pays 80%, member pays 20% — until the OOP max.

The list of prescription drugs a plan covers, organized by tier. Tier 1 = generics (lowest cost), Tier 2 = preferred brand, Tier 3 = non-preferred brand, Tier 4 = specialty. The formulary changes annually and impacts member out-of-pocket more than any other plan-design lever.

A pre-tax employee account for healthcare expenses (Health FSA) or dependent care (DCFSA). Use-it-or-lose-it within a plan year, with a small carryover allowed. 2024 limits: $3,200 health, $5,000 DCFSA.

A triple-tax-advantaged account paired with a qualifying HDHP. Contributions are pre-tax, growth is tax-free, and qualified withdrawals are tax-free. Funds roll over indefinitely. 2024 limits: $4,150 single / $8,300 family.

An employer-funded account that reimburses employees for qualified medical expenses. Unlike an HSA, only the employer can contribute. Useful for cost-shifting strategies on high-deductible plans.

A medical plan with a higher deductible than a traditional plan in exchange for lower premiums. To qualify a member for an HSA in 2024, the plan must have at least a $1,600 deductible (single) and OOP max no greater than $8,050 (single).

A relatively new (2020) HRA structure that lets employers reimburse employees for the cost of individual ACA marketplace coverage instead of offering a group plan. Must be offered to defined classes of employees on uniform terms.

For brokers: ICHRA is one of the fastest-growing market segments — small-business brokers serving 2–50 lives often pivot here when carriers tighten small-group underwriting.

A precursor to ICHRA, available only to employers with under 50 FTEs that don't offer a group health plan. Tax-advantaged reimbursement of individual-market coverage. 2024 limits: $6,150 single / $12,450 family.

The 1974 federal law that governs employer-sponsored benefits. Sets fiduciary standards, disclosure requirements (the SPD comes from here), claims procedures, and enforcement. Self-funded plans are exempt from state insurance regulation under ERISA preemption.

Authority: DOL ERISA overview ↗

The annual return employers (and unions) must file for ERISA-covered benefit plans with 100+ participants. Filed with DOL/IRS. Public-record dataset including plan sponsor, participants, assets, broker of record, carrier, and plan-year financials.

For brokers: Form 5500 is the public dataset Velora's Signal Engine pulls from. Recent broker-of-record changes, late filings, and below-median benefits cost are all real outreach signals.

Authority: DOL Form 5500 search ↗

1991 federal law restricting telemarketing calls, autodialer use, prerecorded messages, and SMS marketing. Enforced via private right of action with statutory damages — $500 per violation, $1,500 if willful. State laws (FL Mini-TCPA, WA Mini-TCPA, OK Mini-TCPA, MD Mini-TCPA) extend liability.

For brokers: Velora enforces TCPA at the dispatch layer with a 51-state matrix. Quiet hours, day-of-week rules, AI-voice disclosure preambles for TX SB 140 and CA AB 2905 — the platform refuses to send when a state rule isn't met.

Authority: 47 USC § 227 ↗

The wireless carrier industry trade association. Publishes the SMS messaging principles every U.S. carrier enforces — STOP/HELP keywords, opt-in confirmation, unsolicited messaging definitions. CTIA non-compliance = carrier-level filtering before messages reach the recipient.

Authority: CTIA Messaging Principles ↗

10-digit long code A2P registration — the carrier program that sanctions sending app-to-person SMS from a regular phone number. Brand registration + campaign registration required; non-registered traffic gets aggressively filtered.

For brokers: Every broker using SMS through Velora gets walked through 10DLC during onboarding. The Twilio bridge handles brand and campaign registration as part of the standard setup.

2003 federal law requiring commercial emails to identify the sender, disclose advertising intent, include a working unsubscribe link, and honor opt-outs within 10 business days. Penalties up to $50,120 per email.

Authority: FTC CAN-SPAM compliance guide ↗

A request from an individual to a company to access, delete, port, correct, or stop processing their personal data. Required by GDPR (30-day timeline), CCPA/CPRA (45-day timeline), and most U.S. state privacy laws (CO, VA, CT, UT, etc.).

For brokers: Velora maintains DSAR workflow at /admin/dsar with deadline tracking. Submit a DSAR to Velora at /privacy.

1996 federal law that, among other things, sets a federal floor for protecting individually identifiable health information (PHI). Covered entities = health plans, healthcare providers, healthcare clearinghouses. Business associates = vendors that touch PHI on their behalf.

For brokers: Velora Marketing does not currently process PHI by default — ingestion is scoped to non-PHI fields. A HIPAA-aware mode for agencies that handle PHI is on the roadmap; we will require a signed BAA before enabling it.

Authority: HHS HIPAA for professionals ↗

A contract required under HIPAA whenever a covered entity uses a vendor to handle PHI on their behalf. Specifies what PHI the vendor receives, how they protect it, breach notification obligations, and termination clauses.

2010 federal law restructuring the individual and group health insurance markets. Created the marketplaces, the employer mandate (50+ FTE = must offer coverage), individual mandate (now $0 federally), and key plan-design floors (preventive care 100%, OOP max caps, no annual/lifetime limits, dependent coverage to age 26).

Federal law allowing former employees (and qualifying dependents) to continue group health coverage for 18–36 months at their own expense. Employers with 20+ employees must offer it.

A funding arrangement where the employer pays a fixed monthly premium to a carrier, and the carrier bears all claims risk. Premiums are subject to state insurance regulation and ACA medical-loss-ratio rules.

A funding arrangement where the employer pays claims directly out of cash flow (often through a TPA), bears the claims risk, and typically buys stop-loss insurance to cap downside. ERISA-preempted from state insurance regulation.

A self-funded variant marketed mostly to small/midsize employers. Predictable monthly payments cover claims funding, admin, and stop-loss. Surplus refunds at year-end if claims run below expected.

Insurance that caps the employer's claims exposure on a self-funded plan. Specific stop-loss caps per-claim cost; aggregate stop-loss caps total annual claims. Stop-loss carriers require detailed claims experience to underwrite.

The ratio of premium dollars spent on member medical care vs. admin and profit. ACA requires fully insured plans to spend at least 80% (small group / individual) or 85% (large group) on medical care or rebate the difference.

The annual cycle when an employer's group health plan re-prices, often with a new carrier or a redesigned plan. The 90 days before renewal are when most broker conversations and plan changes happen.

For brokers: Velora's Renewal Autopilot triggers a renewal-month cadence at T-150, T-90, T-60, T-30, and post-nurture. Producers don't have to remember the calendar.

The annual window when employees can enroll in, change, or drop their group benefits coverage. Usually 2–4 weeks. Outside OE, changes require a qualifying life event (marriage, birth, loss of other coverage).

A life change that triggers a special enrollment period — marriage, divorce, birth/adoption, loss of other coverage, change in employment status, dependent reaching age 26.

The broker designated by an employer as their agent for a specific plan or carrier relationship. AOR letters are the formal mechanism brokers use to assume an account from a previous broker.

Synonym for Agent of Record in many markets. The broker on file with the carrier, paid commission on the policy.

For brokers: BOR changes are a strong outreach signal — Velora's Signal Engine flags them via the public Form 5500 dataset and surfaces them as same-day prospects.

A voicemail dropped directly into the recipient's voicemail box without ringing the phone. Carrier permissibility is jurisdictionally specific; Velora dispatches via Slybroadcast under explicit recipient consent and TCPA-compliant lists.

A predefined sequence of outreach touches across channels (email → SMS → call → voicemail → LinkedIn) with timing, branching, and reply-routing logic.

For brokers: Velora ships seven channels in a single cadence — the playbook layer is the configuration; the channel layer is the dispatch. One config, all channels, one set of rules.

A placeholder in a message template that resolves at send time to a per-recipient value — {first_name}, {company}, {renewal_month}, etc.

For brokers: Velora's broker-native merge tags include SIC code, enrolled lives, current carrier, renewal month, and plan year — fields generic outbound platforms don't model.

The probability that a sent email lands in the recipient's inbox vs. spam folder vs. nowhere. Driven by domain reputation, authentication (SPF/DKIM/DMARC), engagement signals, list hygiene, and content factors.

The three email authentication standards. SPF declares which servers can send for your domain; DKIM cryptographically signs each message; DMARC tells receivers what to do when SPF or DKIM fails. Yahoo + Google now require DMARC for any sender doing 5,000+ messages/day.

An RFC 8058 email header that lets receivers (Gmail, Yahoo, Outlook) render a one-click unsubscribe button. Required by Yahoo + Google for senders doing 5,000+ messages/day. Velora ships List-Unsubscribe + List-Unsubscribe-Post on every email by default.

Authority: RFC 8058 ↗

AI labeling of an inbound message (email reply, SMS, voicemail, LinkedIn DM) into discrete categories — interested, not-now, unsubscribe, bounce, OOO, question — so the cadence engine can fire the right deterministic action.

A go-to-market motion that targets a finite list of named accounts with personalized outreach, instead of running broad demand-gen. Three flavors: 1:1 strategic, 1:Few cluster, 1:Many programmatic.

The system-of-record for a brokerage's book — clients, plans, policies, commissions, renewals. Common AMSes in benefits: Applied Epic, AMS360, Zywave, AgencyZoom (low-end). Distinct from a CRM, which manages prospects and pipeline.

A vendor that processes claims, manages eligibility, and handles plan administration for a self-funded employer. Self-funded plans almost always use a TPA rather than building their own claims operation.

Standard Industrial Classification code — a 4-digit industry classifier the federal government has used since 1937. NAICS codes officially replaced SIC in 1997, but SIC is what's still on most ERISA Form 5500 filings.

For brokers: Velora indexes brokers' books and prospect lists by SIC code so renewal-month cadences can be filtered to industry-relevant content (e.g. construction-specific safety messaging in plan-comparison emails).

The 6-digit successor to SIC, replacing it for federal statistical purposes in 1997. Most modern data systems use NAICS; Form 5500 still uses SIC. Both classifiers are mappable.

The count of employees + dependents covered under a benefits plan. Distinct from "employees offered coverage" (some decline) or "FTE count" (full-time equivalents for ACA mandate purposes).

For brokers: Enrolled lives is the metric carriers use to set commissions and the metric Velora uses to segment cadences (small / mid / enterprise tiers).