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A term used to refer to the comprehensive set of benefits covered for children in Medicaid.
- 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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In certain states, the Marketplace doesn't provide the final decision on Medicaid eligibility. Instead, the Marketplace conducts an assessment and passes the application to the State Medicaid agency to conduct a final eligibility determination.
- Browse Related Terms: Eligibility Assessment, Eligibility determination, Eligible Immigration Status, Federally Recognized Tribe, Grievance, Home and Community-Based Services (HCBS), Notice, State Insurance Department, TTY
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A notice sent by MNsure to let a MNsure consumer know the decision about whether the consumer qualifies (is eligible) for MNsure programs.
- Browse Related Terms: Eligibility Assessment, Eligibility determination, Eligible Immigration Status, Federally Recognized Tribe, Grievance, Home and Community-Based Services (HCBS), Notice, State Insurance Department, TTY
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An immigration status that's considered eligible for getting health coverage through the Marketplace. The rules for eligible immigration status may be different in each insurance affordability program.
- Browse Related Terms: Eligibility Assessment, Eligibility determination, Eligible Immigration Status, Federally Recognized Tribe, Grievance, Home and Community-Based Services (HCBS), Notice, State Insurance Department, TTY
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- (see "pre-existing condition") A period of time before benefits are payable.
- Browse Related Terms: Creditable Coverage, Creditable Coverage or Prior Qualifying Coverage, Disclosure, Discount Health Plan, Elimination period, Exclusion, High Risk Pool Plan (State), High-risk pool, Maryland Health Insurance Program (MHIP), Minnesota Comprehensive Health Association (MCHA), Portability, Pre-existing Condition, Pre-Existing Condition (Job-based Coverage), Pre-existing condition exclusion, Pre-Existing Condition Exclusion Period (Individual Policy), Pre-Existing Condition Exclusion Period (Job-based Coverage), Pre-existing Condition Insurance Plan (PCIP), Rider (exclusionary rider)
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An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.
A condition where there is an immediate need for health services. This happens when a person's life or health or ability to get, keep, or regain maximum function is in serious danger.
An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.
- 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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Ambulance services for an emergency medical condition.
Ambulance services for an emergency medical condition.
Ambulance services for an emergency medical condition.
- Browse Related Terms: Complication of Pregnancy, Complications of Pregnancy, Emergency Medical Transportation, Emergency Room Care, Emergency Services, Service Area
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Emergency services you get in an emergency room.
Emergency services you get in an emergency room.
Emergency services you get in an emergency room.
- Browse Related Terms: Complication of Pregnancy, Complications of Pregnancy, Emergency Medical Transportation, Emergency Room Care, Emergency Services, Service Area
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Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
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is a comprehensive and complex statute that federalizes the law of employee benefits. ERISA applies to most kinds of employee benefit plans, including plans covering health care benefits, which are called employee welfare benefit plans.
- 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
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- Employer choice allows small employers to select one insurance company and allow employees to choose from any plans offered by that company across all metal levels.
- Browse Related Terms: COBRA, COBRA coverage, Employer Choice, Employee Choice, Employer Contribution, Employer or Union Retiree Plans, Flexible Benefits Plan, Fully Insured Job-based Plan, Group Health Plan, Health Reimbursement Account (HRA), Job-based Health Plan, Large Group Health Plan, Medicare Hospital Insurance Tax, Premium, Self-insured, Self-Insured Plan, Small Employer, Third Party Administrator (TPA), Wellness Programs, Worker's compensation
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Employer contribution is the amount or percentage of health care premiums contributed by employers for employees’ health insurance.
- Browse Related Terms: COBRA, COBRA coverage, Employer Choice, Employee Choice, Employer Contribution, Employer or Union Retiree Plans, Flexible Benefits Plan, Fully Insured Job-based Plan, Group Health Plan, Health Reimbursement Account (HRA), Job-based Health Plan, Large Group Health Plan, Medicare Hospital Insurance Tax, Premium, Self-insured, Self-Insured Plan, Small Employer, Third Party Administrator (TPA), Wellness Programs, Worker's compensation
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Plans that provide health and/or drug coverage to former employees or members, and, in some cases, their families. These plans are offered to people through their (or a spouse's) former employer or employee organization. Many of these plans aren't legally required to meet many of the provisions of the Affordable Care Act, including providing coverage for children up to age 26.
- Browse Related Terms: COBRA, COBRA coverage, Employer Choice, Employee Choice, Employer Contribution, Employer or Union Retiree Plans, Flexible Benefits Plan, Fully Insured Job-based Plan, Group Health Plan, Health Reimbursement Account (HRA), Job-based Health Plan, Large Group Health Plan, Medicare Hospital Insurance Tax, Premium, Self-insured, Self-Insured Plan, Small Employer, Third Party Administrator (TPA), Wellness Programs, Worker's compensation
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The Affordable Care Act requires certain employers with at least 50 full-time employees (or equivalents) to offer health insurance coverage to its full-time employees (and their dependents) that meets certain minimum standards set by the Affordable Care Act or to make a tax payment called the ESRP.
- 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
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The ACA requires all health insurance plans sold after 2014 to include a basic package of benefits including hospitalization, outpatient services, maternity care, prescription drugs, emergency care and preventive services among other benefits. It also places restrictions on the amount of cost-sharing that patients must pay for these services.
- 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
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All plans offered on Maryland Health Connection must cover Essential Health Benefits (EHBs) such as hospitalizations, doctor visits, prescription drugs, rehabilitation and mental health services, maternity and newborn care. Other EHBs include emergency care, pediatric care, including dental and vision benefits and laboratory tests. All plans must also cover preventive and wellness care, as well as chronic disease management, at no extra cost to you, including: flu and pneumonia shots, birth control, routine vaccinations and screenings for cancer, such as mammograms and colonoscopies.
A set of health care service categories that must be covered by certain plans, starting in 2014.
- 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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In evidence-based medicine, treatment success is measured by a careful study of the outcome, using both the clinical expertise of the provider, as well as the most up-to-date research available.
- 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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Exchanges refers to state and federal health insurance exchanges. Maryland’s state insurance marketplace is called Maryland Health Connection.
The ACA creates an Exchange in each state to assist individuals and small businesses in comparing and purchasing qualified health insurance plans. Exchanges will also determine who qualifies for subsidies and make subsidy payments to insurers on behalf of individuals receiving them. They will also accept applications for other health coverage programs such as Medicaid and CHIP.
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Drugs not covered by the insurance policy.
- 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
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Health care services that your health insurance or plan doesn’t pay for or cover.
Health care services that your health insurance or plan doesn’t pay for or cover.
Health care services that your health insurance or plan doesn’t pay for or cover.
- 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)