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