Vocabulary

• Health Insurance – A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.
• Premium – The amount you pay for your health insurance every month.
• Deductible – The amount you pay for covered health care services before your insurance plan starts to pay.
• Copayment – A fixed amount you pay for a covered health care service, usually when you get the service.
• Coinsurance – Your share of the costs of a covered health care service, calculated as a percentage of the allowed amount for the service.
• Out-of-pocket maximum – The most you have to pay for covered services in a plan year.
• Network – The facilities, providers, and suppliers your health insurer has contracted with to provide health care services.
• HMO (Health Maintenance Organization) – A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO.
• PPO (Preferred Provider Organization) – A type of health insurance plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers.
• POS (Point of Service) plan – A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network.
• EPO (Exclusive Provider Organization) – A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network.
• High-Deductible Health Plan – A plan with a higher deductible than a traditional insurance plan.
• Health Savings Account – A type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses.
• Flexible Spending Account – An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars.
• Medicare – A federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
• Medicaid – A state and federal program that provides health coverage if you have a very low income.
• Marketplace Plan – Plans sold by insurance companies that have agreed to offer standardized plans through a marketplace.
• Subsidy – A form of financial aid or support extended to an economic sector to promote economic and social policy.
• Catastrophic Health Insurance – Insurance that is designed to give protection against catastrophic losses.
• Long-Term Care Insurance – Insurance that covers care generally not covered by health insurance, Medicare, or Medicaid.
• Disability Insurance – A type of insurance that will provide income in the event a worker is unable to perform their work and earn money due to a disability.
• Group Health Insurance – Coverage through an employer or other entity that covers individuals in a group.
• Individual Health Insurance – Coverage that a person buys independently.
• Underwriting – The process by which an insurance company evaluates an applicant's risk.
• Guaranteed Issue – A rule that requires health plans to offer coverage to all applicants regardless of health status or other factors.
• Self-Insured – A type of insurance where the employer assumes the financial risk for providing health care benefits to its employees.
• Third-Party Administrator – An organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity.
• COBRA – A federal law that may allow you to temporarily keep health coverage after your employment ends.
• Pre-existing Condition – A health problem you had before the date that new health coverage starts.
• Essential Health Benefits – A set of 10 categories of services health insurance plans must cover under the Affordable Care Act.
• Open Enrollment Period – The period of time when you can enroll in or change your health insurance plan.
• Special Enrollment Period – A time outside the yearly Open Enrollment Period when you can sign up for health insurance.
• Qualifying Life Event – A change in your situation that can make you eligible for a Special Enrollment Period.
• Children's Health Insurance Program (CHIP) – Insurance program jointly funded by state and federal government that provides health coverage to children whose parents earn too much income to qualify for Medicaid.
• Primary Care Physician (PCP) – A physician who serves as the first point of care for patients.
• Specialist – A physician who focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.
• Referral – An order from your primary care doctor for you to see a specialist or get certain medical services.
• Preauthorization – A decision by your health insurer that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary.
• Formulary – A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits.
• Generic Drug – A medication that has the same active-ingredient formula as a brand-name drug.
• Brand-Name Drug – A drug sold by a drug company under a specific name or trademark and that is protected by a patent.
• Preferred Provider – A provider who has a contract with your health insurer or plan to provide services to you at a discount.
• Non-Preferred Provider – A provider who doesn't have a contract with your health insurer or plan to provide services to you.
• Balance Billing – When a provider bills you for the difference between the provider’s charge and the allowed amount.
• Allowed Amount – Maximum amount on which payment is based for covered health care services.
• Health Reimbursement Account (HRA) – Employer-funded plan that reimburses employees for incurred medical expenses.
• Summary of Benefits and Coverage (SBC) – An easy-to-read summary that lets you make apples-to-apples comparisons of costs and coverage between health plans.
• Health Home – A coordinated approach to providing health care.
• Telemedicine – A rapidly growing field that allows people to receive medical care through their digital devices, instead of waiting for face-to-face appointments with their doctor.
• Integrated Care – A global term for a service delivery model that aims to create connectivity, alignment and collaboration within and between the cure and care sectors.