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Every day of the calendar month, which includes Saturday, Sunday, and state and federal holidays. However, if any action tied to a time frame in an insurance policy or CDI regulation or code falls on a Saturday, Sunday, or state or federal holiday, then the action is postponed to the next calendar day that does not fall on a Saturday, Sunday, or state or federal holiday.
- Browse Related Terms: Business Day, Calendar Day, Contestability, Grace Period, Mandated benefit, Mandated Health Benefit, Plan Year, Policy Year, Waiting Period
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If you incurred a debt from a loan or from buying something on credit and a portion of the amount you owe is discharged or forgiven ("cancelled"), the amount of the forgiven debt is generally counted as income to you.
- Browse Related Terms: Alimony, Cancelled Debts, Capital Gains, dividend, Income Level, Investment Income, Net Rental Income, Rental or Royalty Income, Self-Employment Income
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A capital gain is the amount you get from selling property, like stock or a house. For example, if you buy stock for $1,000 and sell it for $1,250, you have capital gain of $250. You don't need to include a capital gain if it's from the sale of your main home you owned for at least 5 years (and the profit is less than $250,000).
- Browse Related Terms: Alimony, Cancelled Debts, Capital Gains, dividend, Income Level, Investment Income, Net Rental Income, Rental or Royalty Income, Self-Employment Income
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A flat per patient fee paid to providers no matter how many services they have provided.
- Browse Related Terms: Capitation, claim, External Review, Federally Qualified Health Center (FQHC), Fee-for-Service, Health Care Workforce Incentive, Home Health Care, Internal review, Member Survey Results, Original Medicare, Penalty, Uncompensated Care, Value-Based Purchasing (VBP)
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The organization of your treatment across several health care providers. Medical homes and Accountable Care Organizations are two common ways to coordinate care.
- 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
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A company that provides health insurance plans.
- Browse Related Terms: Appeal, Attest/Attestation, Carriers, Certificate of Coverage, Certificate of Creditable Coverage, Exclusions and/or Limitations, Independent Medical Review (IMR), Insurance Company, Medical Underwriting, policy, Reinsurance, Solvency, Summary of Benefits and Coverage, Summary of Benefits and Coverage (SBC)
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Catastrophic health insurance is a type of health insurance that typically has very high deductibles. The coverage for a catastrophic policy does not kick in until you have paid your share of the deductible amount in the policy.
“High Deductible Health Plans (HDHPs)” are catastrophic health insurance policies created as a way to lower overall medical costs by providing a lower monthly premium in exchange for a higher annual health insurance deductible. With catastrophic health insurance plans, you pay for almost all medical care until you reach the annual deductible amount. If eligible, some people combine a high deductible health policy with a Health Savings Account (HSA). Read the policy carefully to understand what will be covered and how much your share of the costs will be if you need medical treatment.
- 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
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Health plans that meet all of the requirements applicable to other Qualified Health Plans (QHPs) but that don't cover any benefits other than 3 primary care visits per year before the plan's deductible is met. The premium amount you pay each month for health care is generally lower than for other QHPs, but the out-of-pocket costs for deductibles, copayments, and coinsurance are generally higher. To qualify for a catastrophic plan, you must be under 30 years old OR get a "hardship exemption" because the Marketplace determined that you’re unable to afford health coverage.
- 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
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A catastrophic plan covers an individual or family in the event of a major medical emergency. While the plan offers low monthly premiums that often make it more affordable than other plans, its deductible is much higher. This means that the individual or family typically pays out of pocket for most medical care unless there is a catastrophic event. To qualify for a catastrophic plan, an individual must be under 30 years old or receive a “hardship exemption,” which is a determination that they are unable to afford health coverage.
- 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
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The federal agency that runs the Medicare, Medicaid, and Children's Health Insurance Programs, and the federally facilitated Marketplace.
- Browse Related Terms: Benefits, Centers for Medicare & Medicaid Services (CMS), Children's Health Insurance Program (CHIP), Department of Health and Human Services (HHS), Dependent Coverage, Disability, Domestic Partnership, Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT), Federal Poverty Level (FPL), fee, Health Coverage, Health Insurance Marketplace, Maryland Children’s Health Program (MCHP), Medicaid, Medicaid/Medical Assistance, Metal Level, State Health Insurance Assistance Program (SHIP), State Medical Assistance Office, Subsidized Coverage, TRICARE
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A document issued to a member of a group health insurance plan showing evidence of participation in the insurance.
- Browse Related Terms: Appeal, Attest/Attestation, Carriers, Certificate of Coverage, Certificate of Creditable Coverage, Exclusions and/or Limitations, Independent Medical Review (IMR), Insurance Company, Medical Underwriting, policy, Reinsurance, Solvency, Summary of Benefits and Coverage, Summary of Benefits and Coverage (SBC)
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A written statement from your prior insurance company or health plan documenting the length of time you were covered.
- Browse Related Terms: Appeal, Attest/Attestation, Carriers, Certificate of Coverage, Certificate of Creditable Coverage, Exclusions and/or Limitations, Independent Medical Review (IMR), Insurance Company, Medical Underwriting, policy, Reinsurance, Solvency, Summary of Benefits and Coverage, Summary of Benefits and Coverage (SBC)
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An individual (affiliated with a designated organization) who is trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including helping them complete eligibility and enrollment forms. Their services are free to consumers.
- Browse Related Terms: Certified Applicant Counselor, Co-op, In Person Assistance Personnel Program, Individual Health Plan, Insurance Co-Op, navigator, Stand-Alone Coverage
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Insurance program jointly funded by state and federal government that provides health coverage to low-income children and, in some states, pregnant women in families who earn too much income to qualify for Medicaid but can’t afford to purchase private health insurance coverage.
- Browse Related Terms: Benefits, Centers for Medicare & Medicaid Services (CMS), Children's Health Insurance Program (CHIP), Department of Health and Human Services (HHS), Dependent Coverage, Disability, Domestic Partnership, Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT), Federal Poverty Level (FPL), fee, Health Coverage, Health Insurance Marketplace, Maryland Children’s Health Program (MCHP), Medicaid, Medicaid/Medical Assistance, Metal Level, State Health Insurance Assistance Program (SHIP), State Medical Assistance Office, Subsidized Coverage, TRICARE
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A medical condition or disease that goes on for a long period of time. Examples are diabetes and cystic fibrosis.
- Browse Related Terms: Chronic Condition, Durable Medical Equipment (DME), Emergency Medical Condition, Hospice Services, Major Medical Plan, Public Health, Reconstructive Surgery, Special Health Care Need, Urgent Care
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An integrated care approach to managing illness which includes screenings, check-ups, monitoring and coordinating treatment, and patient education. It can improve your quality of life while reducing your health care costs if you have a chronic disease by preventing or minimizing the effects of a disease.
An integrated care approach to managing illness that includes screenings, checkups, monitoring and coordinating treatment and patient education. It can improve your quality of life while reducing your health care costs if you have a chronic disease by preventing or minimizing the effects of a disease.
- 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
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A request for payment that you or your health care provider submits to your health insurer after you receive items or services you think are covered.
A notification to your insurance company that payment is due under the policy provisions.
A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered.
- Browse Related Terms: Capitation, claim, External Review, Federally Qualified Health Center (FQHC), Fee-for-Service, Health Care Workforce Incentive, Home Health Care, Internal review, Member Survey Results, Original Medicare, Penalty, Uncompensated Care, Value-Based Purchasing (VBP)
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All > Healthcare > Health Insurance
Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.
After you have met the deductible for the covered period of time, your health policy may have a “co-insurance” that provides the patient will be responsible for a certain percentage of medical costs after the deductible has been met.
- 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
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A non-profit organization in which the same people who own the company are insured by the company. Cooperatives can be formed at a national, state, or local level and can include doctors, hospitals, and businesses as member-owners. Co-ops will offer insurance through the Marketplace.
- Browse Related Terms: Certified Applicant Counselor, Co-op, In Person Assistance Personnel Program, Individual Health Plan, Insurance Co-Op, navigator, Stand-Alone Coverage
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A “co-pay” is a fixed payment amount that is the responsibility of the patient. For example, a health policy may state that the patient must make a $25 co-pay for each doctor visit, and/or that the patient must pay $15 co-pay for each covered prescription medication that is purchased. (These amounts are examples, your policy may have different co-payment amounts.) The patient, or covered person, must make the required payment each time covered services are used. The amount of any required co-pays should be specified in the policy you select.
- 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