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Glossary
Glossary
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A
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B
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C
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D
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E
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F
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G
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H
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I
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J
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K
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L
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M
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N
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O
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P
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Q
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R
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S
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T
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U
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V
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W
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Z
A
Accountable Care Organization
Actuarial Value
Adjusted Gross Income (AGI)
Advanced Premium Tax Credits (APTC)
Affordable Care Act
Affordable Health Coverage
Agent
Allowed Amount
Ambulatory Surgery Centers
Annual Deductible Combined
Annual Limit
Appeal
Association Health Plans
Authorized Representative
B
Balance Billing
Benefit Year
Benefits
Biological Drug
Biosimilar Drug
Brand-Name Drug
Bronze Health Plan
C
Cadillac Tax
Calendar Year
Care Coordination
Catastrophic Health Insurance
Centers for Medicare & Medicaid Services
Certified Application Counselor
Children's Health Insurance Program (CHIP)
Claim
COBRA
Coinsurance
Community Rating
Conversion
Cooperatives (Co-op)
Coordination of Benefits
Copayment
Cosmetic Surgery
Cost Sharing Expenses
Counterfeit Prescriptions
Covered Services
Creditable Coverage
D
Deductibles
Dental Coverage
Department of Health and Human Services (HHS)
Dependent Coverage
Disability
Domestic Partnership
Donut Hole
Drug List
Durable Medical Equipment (DME)
E
Eligible Immigration Status
Emergency Room Care
Emergency Room Charges
Emergency Services
Employer Retiree Plans
Employer Shared Responsibility Payment
Essential Health Benefits
Exchange
Excluded Services
Exclusive Provider Organization (EPO)
Exemption
Exemption Certificate Number (ECN)
Explanation of Benefits (EOB)
External Reviews
F
Family and Medical Leave Act (FMLA)
Family Glitch
Federal Poverty Level (FPL)
Federally Qualified Health Center (FQHC)
Federally Recognized Tribe
Fee For Service
Flexible Benefits Plan
Flexible Spending Account (FSA)
Formulary
Full-Time Employee (FTE)
G
Generic Drug
Gold Health Plan
Grace Period
Grandfathered
Grandfathered Health Plan
Grievance
Group Health Plan
Guaranteed Issue
Guaranteed Renewal
H
Habilitative Services
Hardship Exemption
Health Coverage
Health Insurance Marketplace
Health Maintenance Organization (HMO)
Health Plan Categories
Health Reimbursement Account (HRA)
Health Savings Account (HSA)
High Deductible Health Plan (HDHP)
High-Cost Excise Tax
High-Risk Pool Plan
HIPAA Eligible Individual
Home and Community-Based Services (HCBS)
Home Health Care
Hospice Services
Hospital Outpatient Care
Hospital Readmissions
Hospitalization
Households
I
In-network Coinsurance
In-network Copayment
Individual Health Insurance Policy
Inpatient
Insurance Co-Op
J
Job-based Health Plan
L
Large Group Health Plan
Lawfully Present
Lifetime Limit
Lifetime Maximum
Limited Cost Sharing Plan
Long-Term Care
M
Marketplaces
Medicaid
Medical Loss Ratio (MLR)
Medical Underwriting
Medically Necessary
Medicare
Medicare Advantage
Medicare Hospital Insurance Tax
Medicare Part D
Medicare Prescription Drug Donut Hole
Minimum Essential Coverage (MEC)
Minimum Value
Modified Adjusted Gross Income
Multi-State Plan
Multiemployer Health Plan
N
Navigator
Network
New Plan
Non-Participating Provider
Non-Preferred Provider
Nondiscrimination
Not Yet Accredited (Health Plan)
O
Obamacare
OOPM
Open Enrollment
Original Medicare
Out-of-Network Coinsurance
Out-of-Network Copayment
Out-of-Pocket Costs
Out-of-Pocket Estimate
Out-of-Pocket Limit
Out-of-Pocket Maximum Limit
Outpatient
Outpatient Surgery Centers
P
Participating Provider
Patient Protection and Affordable Care Act
Patient-Centered Outcomes Research
Penalty
Plan ID
Plan Year
Plastic Surgery
Platinum Health Plan
Point of Service (POS)
Policy Year
Pre-Existing Condition
Pre-registration
Preauthorization
Precertification
Preferred Provider
Preferred Provider Organization (PPO)
Premium
Premium Tax Credit
Prescription Drug Coverage
Prescription Drug Plan (PDP)
Preventive Service
Primary Care
Primary Care Physician (PCP)
Prior Authorization
Public Charge
Public Health
Q
Qualified Health Plans
Qualified Medical Expenses (QME)
Qualifying Health Coverage
Qualifying Life Event (QLE)
Quality Ratings
R
Rate Review
Reasonable and Customary
Reconcile
Reconstructive Surgery
Referral
Rehabilitation Services
Reinsurance
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
Short-term Insurance
Silver Health Plan
Skilled Nursing Care
Social Security
Special Enrollment Period (SEP)
Special Health Care Need
Specialist
Specialty Drug
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
Tax Filing Requirement
Tax Filing Requirement (Dependents)
Tax Household
Tier (Drugs)
Transgender People
TRICARE
TTY
U
UCR (Usual, Customary, and Reasonable)
Uncompensated Care
Urgent Care
V
Value-Based Purchasing (VBP)
Vision Coverage
W
Waiting Period
Well-baby and Well-child Visits
Wellness Programs
Worker's Compensation
Z
Zero Cost Sharing Plan
