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A Federal law that guarantees up to 12 weeks of job protected leave for certain employees when they need to take time off due to serious illness or disability, to have or adopt a child, or to care for another family member. When on leave under FMLA, you can continue coverage under your job-based plan.
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A measure of income level issued annually by the Department of Health and Human Services. Federal Poverty Levels are used to determine your eligibility for certain programs and benefits.
A measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits.
- 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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Federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. Federally qualified health centers provide primary care services regardless of your ability to pay. Services are provided on a sliding scale fee based on your ability to pay.
- 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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Any Indian or Alaska Native tribe, band, nation, pueblo, village or community that the Department of the Interior acknowledges to exist as an Indian tribe.
- 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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- If someone doesn't have a health plan that qualifies as minimum essential coverage, he or she may have to pay a fee that increases every year: from 1% of income (or $95 per adult, whichever is higher) in 2014 to 2.5% of income (or $695 per adult) in 2016. The fee for children is half the adult amount. The fee is paid on the 2014 federal income tax form, which is completed in 2015. People with very low incomes and others may be eligible for waivers.
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A method in which doctors and other health care providers are paid for each service performed. Examples of services include tests and office visits.
A system in which you pay the provider for each single service or procedure.
- 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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A benefit program that offers employees a choice between various benefits including cash, life insurance, health insurance, vacations, retirement plans, and child care. Although a common core of benefits may be required, you can choose how your remaining benefit dollars are to be allocated for each type of benefit from the total amount promised by the employer. Sometimes you can contribute more for additional coverage. Also known as a Cafeteria plan or IRS 125 Plan.
- 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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An arrangement you set up through your employer to pay for many of your out-of-pocket medical expenses with tax-free dollars. These expenses include insurance copayments and deductibles, and qualified prescription drugs, insulin and medical devices. You decide how much of your pre-tax wages you want taken out of your paycheck and put into an FSA. You don’t have to pay taxes on this money. Your employer’s plan sets a limit on the amount you can put into an FSA each year.
- 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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- See "drug formulary."
The list of drugs covered fully or in part by a health plan.
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
- 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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An employee who works an average of at least 30 hours per week (so part-time would be less than 30 hours per week).
- 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 number of working hours that represents one full-time employee during a fixed time period, such as one month or one year. FTE simplifies work measurement by converting work load hours into the number of people required to complete that work. Any Maryland business with one to 50 full-time equivalent (FTE) employees is considered a small business and is eligible to use the SHOP.
- 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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A health plan purchased by an employer from an insurance company.
- 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