All > Healthcare > Health Insurance
An ”access fee” is a specific amount that a person covered under the policy must pay each time certain services are used or received. The access fee is not part of the deductible amount, and is not usually reimbursed by the health insurance carrier.
- Browse Related Terms: Access Fee, Catastrophic Health Insurance, Catastrophic Health Plan, Co-insurance, Co-pay, Co-payment, Coinsurance, Cost Sharing, Deductible, Doctor Visits, Limited Benefit Health Insurance Policies, Medicare Supplement (Medigap) Insurance, Out-of-Pocket Costs, Out-of-Pocket Limit, Out-of-Pocket Maximum, Out-of-pocket maximum/limit, Stop-Loss
All > Healthcare > Health Insurance
A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organization's payment is tied to achieving health care quality goals and outcomes that result in cost savings.
- Browse Related Terms: Accountable Care Organization, Chronic Disease Management, Disease managem ent, Essential Health Benefits, prevention, preventive, Preventive Medicine, Preventive Services, Well-baby and Well-child Visits
All > Healthcare > Health Insurance
If a Marketplace health plan is approved, this is the “seal of approval” given to the plan by an independent organization to show that the plan meets national quality standards.
- Browse Related Terms: Accreditation, Biosimilar Biological Products, Denial, Experimental and/or Investigational Medical Services, Not Yet Accredited (Health Plan), Pre-authorization, Preauthorization, Prior Authorization, Provider
Also listed in:
- All > Technology > Security
- All > Technology > Telecommunications
- All > Travel > Tourism
All > Healthcare > Health Insurance
The demonstration by an insurer that the premiums collected are reasonable, given the benefits provided under the plan or that the distribution of premiums among policyholders are proportional to the distribution of their expected costs, subject to limitations of state and federal law. Minn. Stat. 62A.02 requires companies to file rates for individual health insurance products and provide certain actuarial justification. The actuarial justification is reviewed before rates are approved.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
All > Healthcare > Health Insurance
The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.
The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.
- Browse Related Terms: Actuarial Value, Benefit Level, Coordination of Benefits, Dental Coverage, Excluded Services, Hospital Outpatient Care, Major Medical Health Insurance, Net Capital Gains, Subsidy, Total Cost Estimate (for health coverage)
All > Healthcare > Health Insurance
One step below a hospital, an acute care facility gives advanced medical and nursing services to bring you back to health.
Also listed in:
All > Healthcare > Health Insurance
A way of pricing insurance where premiums are not based upon a policyholder's health status, but may be based upon other factors, such as age and geographic location. The ACA requires the use of adjusted community rating, with maximum variation for age of 3:1 and for tobacco use of 1.5:1.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
All > Healthcare > Health Insurance
The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you're due, you'll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return. Also called premium tax credit.
- Browse Related Terms: Advanced Premium Tax Credit, Banding, Catastrophic Plan, Consumer Operated and Oriented Plans, dependent, Hardship Exemption, Health Savings Account (HSA), High deductible health plan (HDHP), High-Cost Excise Tax, Individual mandate, MinnesotaCare, Payment Frequency, Premium Tax Credit, Risk corridor
All > Healthcare > Health Insurance
The 2010 Patient Protection and Affordable Care Act (ACA) requires states to establish and operate a health insurance exchange by 2014, or to participate in a federal exchange. Maryland opted to create Maryland Health Connection, a marketplace for Marylanders to shop for and enroll in health plans.
The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.
- Browse Related Terms: Affordable Care Act, Affordable Care Act (ACA), Grandfathered, Grandfathered Health Plan, Grandfathered plan, New Plan, Patient Protection and Affordable Care Act, Patient Protection and Affordable Care Act (PPACA), Reconciliation Act
All > Healthcare > Health Insurance
This is the title usually given to the federal health reform passed in March 2010 and collectively refers to the provisions of the Patient Protection and Affordability Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (Reconciliation Act).
- Browse Related Terms: Affordable Care Act, Affordable Care Act (ACA), Grandfathered, Grandfathered Health Plan, Grandfathered plan, New Plan, Patient Protection and Affordable Care Act, Patient Protection and Affordable Care Act (PPACA), Reconciliation Act
All > Healthcare > Health Insurance
- Employer coverage is considered affordable - as it relates to the Advanced Premium Tax Credit (APTC) - if the employee’s share of the annual premium for self-only coverage is no greater than 9.5% of annual household income. Starting in 2014, individuals offered employer-sponsored coverage that’s affordable and provides minimum value won’t be eligible for a premium tax credit.
- Browse Related Terms: Affordable coverage (as it relates to APTC), Employee Retirement Income Security Act of 1974 (ERISA), Employer Shared Responsibility Payment (ESRP), Full-Time Employee, Full-Time Equivalent, Minimum value, Multi-Employer Plan, Open Enrollment, Plan, Tax credit, Vision or Vision Coverage
All > Healthcare > Health Insurance
Varying premiums based on age. The ACA will cap the maximum variation for age at 3:1. Minnesota law already limits maximum variation for age to a 3:1 ratio (Minn. Stat. 62A.65 Subd. 3 for individual policies and 62L.08 Subd. 3 for small group policies).
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
All > Healthcare > Health Insurance
An agent or broker is a person or business who can help you apply for help paying for coverage and enroll you in a Qualified Health Plan (QHP) through the Marketplace. They can make specific recommendations about which plan you should enroll in. They’re also licensed and regulated by states and typically get payments, or commissions, from health insurers for enrolling a consumer into an issuer’s plans. Some agents and brokers may only be able to sell plans from specific health insurers.
In the insurance industry, an agent is appointed by an insurance company to sell insurance policies. The agent represents the insurance company, not the insured.
Also listed in:
- All > Business > Banking
- All > Business > Finance > Insurance > Auto Insurance
- All > Business > Finance > Insurance > Homeowners Insurance
- All > Business > Finance > Personal Finance
- All > Business > Finance > Personal Finance > Mortgage
- All > Law > Bankruptcy
- All > Technology > E-mail > Lotus Domino
- All > Technology > E-mail > Microsoft Email > Microsoft Exchange > Microsoft Exchange 2007
- All > Technology > Programming > Java
- All > Technology > Security
- All > Technology > Storage
- All > Technology > Telecommunications
- All > Travel > Visa
All > Healthcare > Health Insurance
Alimony is money you get from a spouse with whom you no longer live, or a former spouse, if paid to you as part of a divorce agreement, separation agreement, or court order. Payments designated in the agreement or order as child support or as a non-taxable property settlement aren’t alimony.
- Browse Related Terms: Alimony, Cancelled Debts, Capital Gains, dividend, Income Level, Investment Income, Net Rental Income, Rental or Royalty Income, Self-Employment Income
Also listed in:
All > Healthcare > Health Insurance
- Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing)
Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance" or "negotiated rate." If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.)
Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference. (See Balance Billing.)
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
All > Healthcare > Health Insurance
Usually in Health Savings Account (HSA) eligible plans, the total amount that family members on a plan must pay out-of-pocket for health care or prescription drugs before the health plan begins to pay.
- Browse Related Terms: Annual Deductible Combined, Brand Name (Drugs), Donut Hole, Medicare Prescription Drug, Drug Formulary, Drug List, Essential Benefits, Excluded Drugs, Flexible Spending Account (FSA), Formulary, Generic Drug, Generic Drugs, Medicare, Medicare Part D, Medicare Prescription Drug Donut Hole, Name-brand Drug, Out-of-Pocket Estimate, Over-the-Counter Drug, Prescription Drug, Prescription Drug Coverage, Prescription Drugs
All > Healthcare > Health Insurance
For most taxpayers, the household Modified Adjusted Gross Income (MAGI) is the same as Adjusted Gross Income (AGI) which can be found on Line 4 on a Form 1040EZ, Line 21 on a Form 1040A, or Line 37 on a Form 1040.
Taxpayers who receive non-taxable Social Security benefits, earn income living abroad, or earn non-exempt interest should add back that income to AGI to calculate MAGI.
Medicaid eligibility will be determined excluding the following types of income: scholarships, awards, or fellowship grants used for education purposes and not for living expenses, and certain American Indian and Alaska Native income derived from distributions, payments, ownership interests, real property usage rights, and student financial assistance.
The total income for a family in a calendar year.
- Browse Related Terms: Annual Household Income, Modified adjusted gross income (MAGI), Pension (Retirement Benefit), Retirement Benefit (Pension), Social Security, Social Security Benefits, Social Security Survivors Benefits, Supplemental Security Income (SSI), Tax Household
All > Healthcare > Health Insurance
Many health insurance plans place dollar limits upon the claims the insurer will pay over the course of a plan year. PPACA prohibits annual limits for essential benefits for plan years beginning after Sept. 23, 2010.
Many health insurance plans have historically placed dollar limits upon the claims the insurer will pay over the course of a plan year. The ACA restricts annual limits for essential benefits for plan years beginning after Sept. 23, 2010. The cap on annual limits is $750,000 for plan years starting on or after September 23, 2010 but before September 23, 2011 and will increase each year until January 1, 2014 when plans can no longer have annual limits. Grandfathered plans in the individual market are not required to follow the ACA requirements on annual limits. Some plans may be eligible for a waiver from the rules concerning annual dollar limits, if complying with the limit would mean a significant decrease in benefit coverage or a significant increase in premiums.
A cap on the benefits your insurance company will pay in a year while you’re enrolled in a particular health insurance plan. Caps are sometimes placed on particular services such as prescriptions or hospitalizations. Annual limits may be placed on the dollar amount of covered services or on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated health care costs for the rest of the year.
A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan. These caps are sometimes placed on particular services such as prescriptions or hospitalizations. Annual limits may be placed on the dollar amount of covered services or on the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated health care costs for the rest of the year.
- Browse Related Terms: Actuarial justification, Adjusted community rating, Age Rating, Annual Limit, Community rating, Guaranteed Issue, Guaranteed renewability, Guaranteed Renewal, Health Status Rating, Interstate compact, Lifetime limit, Medical Loss Ratio (MLR), Multi-state plan, Qualified health plan, Rate Review, Rating Factors, Rescission, Risk Adjustment, Small group market
All > Healthcare > Health Insurance
A request for your health insurer or plan to review a decision or a grievance again.
A request for your health insurer or plan to review a decision or a grievance again.
A request for a fair review of a decision or action, to see if an error was made.
Also listed in:
- All > Business > Finance > Personal Finance > Income Tax
- All > Law > Bankruptcy
- All > Law > Common Legal Terms
- All > Law > Court
- All > Law > Criminal Law
- All > Law > Divorce
- All > Law > Intellectual Property > Patent
- All > Law > US Legislature
All > Healthcare > Health Insurance
Your signed authorization to your doctor or hospital (medical provider) assigning payment to be made directly to them for your medical treatment.
- Browse Related Terms: assignment, Care Coordination, Evidence-Based Medicine, Hospital Readmissions, Medically Necessary, Patient-Centered Outcomes Research, Payment Bundling, Physician Services, primary care, Primary Care Physician, Primary Care Provider, Provider Category, Specialist
Also listed in:
- All > Business > Finance > Personal Finance
- All > Business > Real Estate
- All > Law > Common Legal Terms
- All > Law > Intellectual Property
- All > Law > Intellectual Property > Patent
- All > Technology > Programming > Perl
- All > Technology > Telecommunications