Glossary



  • Accountable Care Organization
  • Accreditation
  • Actuarial Value
  • Advanced Premium Tax Credit
  • Affordable Care Act
  • Affordable Insurance Exchange
  • Affordable coverage (as it relates to APTC)
  • Agent
  • Alimony
  • Allowed Amount
  • Annual Deductible Combined
  • Annual Limit
  • Appeal
  • Attest/Attestation
  • Authorized Representative
  • Balance Billing
  • Benefits
  • Biosimilar Biological Products
  • Brand Name (Drugs)
  • Broker
  • Bronze Health Plan
  • COBRA
  • Cancelled Debts
  • Capital Gains
  • Care Coordination
  • Catastrophic Health Plan
  • Centers for Medicare & Medicaid Services (CMS)
  • Certified Applicant 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
  • Court Awards
  • Creditable Coverage
  • 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)
  • 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
  • External Review
  • 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
  • Fully Insured Job-based Plan
  • Generic Drugs
  • Gold Health Plan
  • Grandfathered
  • Grandfathered Health Plan
  • Grievance
  • Group Health Plan
  • Guaranteed Issue
  • Guaranteed Renewal
  • 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 Account (HRA)
  • Health Savings Account (HSA)
  • Health Status
  • High Deductible Health Plan (HDHP)
  • High Risk Pool Plan (State)
  • High-Cost Excise Tax
  • Home Health Care
  • Home and Community-Based Services (HCBS)
  • Hospice Services
  • Hospital Outpatient Care
  • Hospital Readmissions
  • Hospitalization
  • In Person Assistance Personnel Program
  • In-network Coinsurance
  • In-network Copayment
  • Individual Health Insurance Policy
  • Inpatient Care
  • Insurance Co-Op
  • Interest
  • Investment Income
  • Job-based Health Plan
  • Large Group Health Plan
  • Lifetime Limit
  • Long-Term Care
  • 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
  • Minimum value
  • Modified Adjusted Gross Income (MAGI)
  • Multi-Employer Plan
  • Navigator
  • Net Capital Gains
  • Net Rental Income
  • Network
  • New Plan
  • Non-preferred provider
  • Nondiscrimination
  • Not Yet Accredited (Health Plan)
  • Notice
  • 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
  • Patient Protection and Affordable Care Act
  • Patient-Centered Outcomes Research
  • Payment Bundling
  • Penalty
  • Pension (Retirement Benefit)
  • Physician Services
  • Plan
  • 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
  • Qualified Health Plan
  • Qualifying Life Event
  • Rate Review
  • Reconstructive Surgery
  • Referral
  • Rehabilitative/Rehabilitation Services
  • Reinsurance
  • Rental or Royalty Income
  • Rescission
  • Retirement Benefit (Pension)
  • Rider (exclusionary rider)
  • Risk Adjustment
  • Self-Employment Income
  • Self-Insured Plan
  • Service Area
  • Silver Health Plan
  • Skilled Nursing Care
  • Skilled Nursing Facility Care
  • Social Security
  • Social Security Benefits
  • Social Security Survivors Benefits
  • Special Enrollment Period
  • Special Health Care Need
  • Specialist
  • 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)
  • TRICARE
  • TTY
  • Tax Household
  • Total Cost Estimate (for health coverage)
  • UCR (Usual, Customary, and Reasonable)
  • Uncompensated Care
  • Urgent Care
  • Value-Based Purchasing (VBP)
  • Vision or Vision Coverage
  • Waiting Period (Job-based coverage)
  • Well-baby and Well-child Visits
  • Wellness Programs
  • Worker's Compensation