Glossary

A

• Abortion services

• Accountable Care Organization

• Accreditation

• Actuarial Value

• Adjusted Gross Income (AGI)

• Advance Premium Tax Credit (APTC)

• Affordable Care Act (ACA)

• Affordable coverage

• Agent and Broker (Health Insurance)

• Alimony

• Allowed Amount

• Annual Deductible Combined

• Annual Limit

• Appeal

• Application ID

• Attest/Attestation

• Authorized Representative

B

• Balance Billing

• Benefit Year

• Benefits

• Biosimilar Biological Products

• Brand Name (Drugs)

• Broker

• Bronze Health Plan

C

• COBRA

• Cafeteria Plan

• Canceled Debts

• Capital Gains

• Care Coordination

• Catastrophic Health Plan

• Centers for Medicare & Medicaid Services (CMS)

• Certified Application Counselor

• Children's Health Insurance Program (CHIP)

• Chronic Disease Management

• Claim

• Co-op

• Coinsurance

• Community Rating

• Competitive Bidding

• Complication of Pregnancy

• Conversion

• Coordination of Benefits

• Copayment

• Cost Sharing

• Cost Sharing Reduction (CSR)

• Court Awards

• Creditable Coverage

D

• Data Matching Issue (Inconsistency)

• Deductible

• Dental Coverage

• Department of Health and Human Services (HHS)

• Dependent

• Dependent Coverage

• Disability

• Dividend

• Domestic Partnership

• Donut Hole, Medicare Prescription Drug

• Drug List

• Durable Medical Equipment (DME)

E

• Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)

• Eligibility Assessment

• Eligible Immigration Status

• Emergency Medical Condition

• Emergency Medical Transportation

• Emergency Room Care

• Emergency Services

• Employer Shared Responsibility Payment (ESRP)

• Employer or Union Retiree Plans

• Essential Health Benefits

• Exchange

• Excluded Services

• Exclusive Provider Organization (EPO) Plan

• Exemption

• Exemption Certificate Number (ECN)

• External Review

F

• Family and Medical Leave Act (FMLA)

• Federal Poverty Level (FPL)

• Federally Qualified Health Center (FQHC)

• Federally Recognized Tribe

• Fee

• Fee for Service

• Flexible Benefits Plan

• Flexible Spending Account (FSA)

• Formulary

• Full-Time Employee (FTE)

• Fully Insured Job-based Plan

G

• Generic Drugs

• Gold Health Plan

• Grace Period

• Grandfathered

• Grandfathered Health Plan

• Grievance

• Group Health Plan

• Guaranteed Issue

• Guaranteed Renewal

H

• HIPAA Eligible Individual

• Habilitative/Habilitation Services

• Hardship Exemption

• Health Care Workforce Incentive

• Health Coverage

• Health Insurance

• Health Insurance Marketplace®

• Health Maintenance Organization (HMO)

• Health Plan Categories

• Health Reimbursement Arrangement (HRA)

• Health Savings Account (HSA)

• Health Status

• High Deductible Health Plan (HDHP)

• High-Cost Excise Tax

• High-Risk Pool Plan (State)

• 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

• Inconsistency (Data Matching Issue)

• Individual Coverage Health Reimbursement Arrangement

• Individual Health Insurance Policy

• Inpatient Care

• Insurance Co-Op

• Interest

• Investment Income

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 Loss Ratio (MLR)

• Medical Underwriting

• Medically Necessary

• Medicare

• Medicare Advantage (Medicare Part C)

• Medicare Hospital Insurance Tax

• Medicare Part D

• Medicare Prescription Drug Donut Hole

• Member Survey Results

• Minimum Essential Coverage (MEC)

• Minimum Value

• Modified Adjusted Gross Income (MAGI)

• Multi-Employer Plan

• Multi-State Plan

N

• Navigator

• Net Capital Gains

• Net Rental Income

• Network

• Network Plan

• New Plan

• Non-preferred provider

• Nondiscrimination

• Not Yet Accredited (Health Plan)

• Notice

O

• Open Enrollment Period

• Original Medicare

• Out-of-Network Coinsurance

• Out-of-Network Copayment

• Out-of-Pocket Costs

• Out-of-Pocket Estimate

• Out-of-pocket maximum/limit

P

• Patient Protection and Affordable Care Act

• Patient-Centered Outcomes Research

• Payment Bundling

• Penalty

• Pension (Retirement Benefit)

• Physician Services

• Plan

• Plan ID

• Plan Year

• Platinum Health Plan

• Point of Service (POS) Plans

• Policy Year

• Pre-Existing Condition

• Pre-Existing Condition (Job-based Coverage)

• Pre-Existing Condition Exclusion Period (Individual Policy)

• Pre-Existing Condition Exclusion Period (Job-based Coverage)

• Pre-existing Condition Insurance Plan (PCIP)

• Preauthorization

• Preferred Provider

• Preferred Provider Organization (PPO)

• Premium

• Premium Tax Credit

• Prescription Drug Coverage

• Prescription Drugs

• Prevention

• Preventive Services

• Primary Care

• Primary Care Physician

• Primary Care Provider

• Prior Authorization

• Public Health

Q

• QSEHRA

• Qualified Health Plan

• Qualifying Health Coverage

• Qualifying Life Event (QLE)

• Quality Ratings (or 'star' ratings)

R

• Rate Review

• Reconcile

• Reconstructive Surgery

• Referral

• Rehabilitative/Rehabilitation Services

• Reinsurance

• Rental or Royalty Income

• Rescission

• Retirement Benefit (Pension)

• Rider (exclusionary rider)

• Risk Adjustment

S

• Same-Sex Marriage

• Second lowest cost Silver plan (SLCSP)

• Self-Employment Income

• Self-Employment Ledger

• Self-Insured Plan

• Service Area

• Silver Health Plan

• Skilled Nursing Care

• Skilled Nursing Facility Care

• Small Business Health Options Program (SHOP)

• Social Security

• Social Security Benefits

• Social Security Survivors Benefits

• Special Enrollment Period (SEP)

• Special Health Care Need

• Specialist

• Spousal Abandonment

• Stand-alone Dental Plan

• State Continuation Coverage

• State Health Insurance Assistance Program (SHIP)

• State Insurance Department

• State Medical Assistance Office

• Subsidized Coverage

• Summary of Benefits and Coverage (SBC)

• Supplemental Security Income (SSI)

T

• TRICARE

• TTY

• Tax Household

• Tax filing requirement

• Tax filing requirement (for dependents)

• Total Cost Estimate (for health coverage)

• Transgender People

U

• UCR (Usual, Customary, and Reasonable)

• Uncompensated Care

• Urban Indian programs

• Urgent Care

V

• Value-Based Purchasing (VBP)

• Vision Coverage

W

• Waiting Period (Job-based coverage)

• Well-baby and Well-child Visits

• Wellness Programs

• Worker's Compensation

Z

• Zero Cost Sharing Plan

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