Glossary

A

Actuarial Value

Affordable Care Act (ACA)

Agent

Annual Limit

Appeal

Authorized Representative

 

B

Balance Billing

Benefit Year

Benefits

Brand Name (Drugs)

Broker

 

C

COBRA

Capital Gains

Catastrophic Health Plan

Children’s Health Insurance Program (CHIP)

Chronic Disease Management

Claim

Co-op

Coinsurance

Community Rating

Competitive Bidding

Conversion

Copayment

Cost Sharing

 

D

Deductible

Dental Coverage

Dependent

Dependent Coverage

Disability

Domestic Partnership

Drug List

 

E

Emergency Medical Condition

Emergency Medical Transportation

Emergency Room Care

Emergency Services

Employer Shared Responsibility Payment (ESRP)

Essential Health Benefits

Exchange

Excluded Services

Exclusive Provider Organization (EPO) Plan

Exemption

 

F

Family and Medical Leave Act (FMLA)

Fee

Fee For Service

Flexible Benefits Plan

Flexible Spending Account (FSA)

Full-Time Employee (FTE)

Fully Insured Job-based Plan

 

G

Generic Drugs

Grievance

Group Health Plan

Guaranteed Issue

Guaranteed Renewal

 

H

HIPAA

Health Coverage

Health Insurance

Health Insurance Marketplace

Health Maintenance Organization (HMO)

Health Reimbursement Account (HRA)

Health Savings Account (HSA)

Health Status

High Deductible Health Plan (HDHP)

Home Health Care

Home and Community-Based Services (HCBS)

Hospice Services

Hospital Outpatient Care

Hospital Readmissions

Hospitalization

Household

 

I

In Person Assistance Personnel Program

In-network Coinsurance

In-network Copayment

Individual Health Insurance Policy

Inpatient Care

Insurance Co-Op

 

J

Job-based Health Plan

 

L

Large Group Health Plan

Lawfully Present

Lifetime Limit

Limited cost sharing plan

Long-Term Care

 

M

Marketplace

Medicaid

Medical Underwriting

Medically Necessary

Medicare

Medicare Advantage (Medicare Part C)

Medicare Hospital Insurance Tax

Medicare Part D

Minimum Essential Coverage (MEC)

Minimum value

 

N

Network

New Plan

Non-preferred provider

Nondiscrimination

 

O

Obamacare

Open Enrollment Period

Out-of-Network Coinsurance

Out-of-Network Copayment

Out-of-Pocket Costs

Out-of-Pocket Estimate

Out-of-pocket maximum/limit

 

P

Payment Bundling

Penalty

Physician Services

Plan

Plan ID

Plan Year

Policy Year

Pre-Existing Condition

Preferred Provider Organization (PPO)

Premium

Premium Tax Credit

Prescription Drugs

Preventive Services

Primary Care Physician

Primary Care Provider

Prior Authorization

Public Health

 

Q

Qualified Health Plan

Qualifying Health Coverage

Qualifying Life Event (QLE)

 

R

Reconcile

Reconstructive Surgery

Referral

Rehabilitative/Rehabilitation Services

Reinsurance

Rider (exclusionary rider)

Risk Adjustment

 

S

Self-Insured Plan

Skilled Nursing Care

Social Security

Special Enrollment Period (SEP)

Specialist

Spousal Abandonment

State Continuation Coverage

Subsidized Coverage

Summary of Benefits and Coverage (SBC)

 

T

Total Cost Estimate (for health coverage)

 

U

Uncompensated Care

Urgent Care

 

V

Vision Coverage

 

W

Waiting Period (Job-based coverage)

Well-baby and Well-child Visits

Wellness Programs

Worker’s Compensation

 

Z

Zero cost sharing plan