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- A drug that is similar to a name-brand drug but not covered by original patents and therefore cheaper. For example, the generic for the name-brand "Vicodin®" is "hydrocodone." If you buy a generic drug, you usually pay less co-pay (see "name-brand drugs").
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A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. The Food and Drug Administration (FDA) rates these drugs to be as safe and effective as brand-name drugs.
- 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 Health Plan Categories
- Browse Related Terms: Bronze Health Plan, Cost Sharing Reduction, Gold Health Plan, Health Plan Categories, Platinum Health Plan, Silver Health Plan
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A specified period immediately following the premium due date during which a payment can be made to continue a policy in force without interruption. This applies only to Life and Health policies. Check your policy to be sure that a grace period is offered and how many days, if any, are allowed.
- 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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As used in connection with the Affordable Care Act: Exempt from certain provisions of this 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
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As used in connection with the Affordable Care Act: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also advise consumers how to contact the U.S. Department of Labor or the U.S. Department of Health and Human Services with questions. (Note: If you are in a group health plan, the date you joined may not reflect the date the plan was created. New employees and new family members may be added to grandfathered group plans after March 23, 2010).
As used in connection with the Affordable Care Act: A group health plan that was created—or an individual health insurance policy that was purchased—on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act. Plans or policies may lose their “grandfathered” status if they make certain significant changes that reduce benefits or increase costs to consumers. A health plan must disclose in its plan materials whether it considers itself to be a grandfathered plan and must also advise consumers how to contact the U.S. Department of Labor or the U.S. Department of Health and Human Services with questions. (Note: If you are in a group health plan, the date you joined may not reflect the date the plan was created. New employees and new family members may be added to grandfathered group plans after March 23, 2010).
- 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
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A health plan that an individual was enrolled in prior to March 23, 2010 is considered a grandfathered plan under the ACA. Grandfathered plans are exempted from most changes required by the ACA. New employees may be added to group plans that are grandfathered, and new family members may be added to all grandfathered plans.
- 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
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A stated dissatisfaction or complaint that is not the same as an appeal.
- A complaint that you communicate to your health insurer or plan.
A complaint that you communicate to your health insurer or plan.
- 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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- When groups of individuals are covered under one insurance contract. Usually people are offered group health plans by their employers (see "individual health plan").
In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.
- 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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A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services. Except in some states, guaranteed issue doesn't limit how much you can be charged if you enroll.
A requirement that health insurers sell a health insurance policy to any person who requests coverage without regard to any pre-existing health conditions. HIPAA already requires guaranteed-issue in the small group market. The ACA requires that all health insurance be sold on a guaranteed-issue basis beginning in 2014. For children under age 19, the guaranteed-issue requirements of the ACA are phased in earlier and begin to take effect on September 23, 2010 for non-grandfathered plans which offer coverage to kids. Minn. Stat. 62L.03 Subd. 1 provides guaranteed issue in the Minnesota's small group market.
A health insurance policy that must be issued regardless of any pre-existing medical condition.
A requirement that health plans must allow you to sign up for coverage, regardless of health status, age, gender, or other factors that might predict how much you use health services. Guaranteed issue doesn’t limit how much you can be charged if you enroll.
- 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
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A requirement that health insurers renew coverage under a health plan except for failure to pay premium, fraud or misrepresentation. HIPAA requires that all health insurance be guaranteed renewable. Minn. Stat. 62A.65 Subd. 2 provides guaranteed renewal in the individual health insurance market and Minn. Stat. 62L.03 Subd. 1 provides guaranteed renewal for the small group market.
- 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
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A requirement that your health insurance issuer must offer to renew your policy as long as you continue to pay premiums. Except in some states, guaranteed renewal doesn't limit how much you can be charged if you renew your coverage.
- 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