All > Healthcare > Health Insurance
Individual or organizations that are trained and able to provide help to consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including helping them complete eligibility and enrollment forms. These individuals and organizations are required to be unbiased. 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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The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-network co-insurance usually costs you less than out-of-network co-insurance.
- Browse Related Terms: Competitive Bidding, Copayment, Coverage, Health Insurance, In-Network Co-Insurance, In-Network Co-Payment, In-network Coinsurance, In-network Copayment, Limited Benefits Plan, network, Network Plan, Non-preferred provider, Out-of-Network Co-Insurance, Out-of-Network Co-Payment, Out-of-network Coinsurance, Out-of-Network Copayment, Preferred Provider
All > Healthcare > Health Insurance
A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network co-payments usually are less than out-of-network co-payments.
- Browse Related Terms: Competitive Bidding, Copayment, Coverage, Health Insurance, In-Network Co-Insurance, In-Network Co-Payment, In-network Coinsurance, In-network Copayment, Limited Benefits Plan, network, Network Plan, Non-preferred provider, Out-of-Network Co-Insurance, Out-of-Network Co-Payment, Out-of-network Coinsurance, Out-of-Network Copayment, Preferred Provider
All > Healthcare > Health Insurance
The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-network coinsurance usually costs you less than out-of-network coinsurance.
The percent (for example, 20%) you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. In-network coinsurance usually costs you less than out-of-network coinsurance.
- Browse Related Terms: Competitive Bidding, Copayment, Coverage, Health Insurance, In-Network Co-Insurance, In-Network Co-Payment, In-network Coinsurance, In-network Copayment, Limited Benefits Plan, network, Network Plan, Non-preferred provider, Out-of-Network Co-Insurance, Out-of-Network Co-Payment, Out-of-network Coinsurance, Out-of-Network Copayment, Preferred Provider
All > Healthcare > Health Insurance
A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network copayments usually are less than out-of-network copayments.
A fixed amount (for example, $15) you pay for covered health care services to providers who contract with your health insurance or plan. In-network copayments usually are less than out-of-network copayments.
- Browse Related Terms: Competitive Bidding, Copayment, Coverage, Health Insurance, In-Network Co-Insurance, In-Network Co-Payment, In-network Coinsurance, In-network Copayment, Limited Benefits Plan, network, Network Plan, Non-preferred provider, Out-of-Network Co-Insurance, Out-of-Network Co-Payment, Out-of-network Coinsurance, Out-of-Network Copayment, Preferred Provider
All > Healthcare > Health Insurance
A health care provider (such as a hospital or doctor) that is contracted to be part of the network for a managed care organization (such as an HMO or PPO). The provider agrees to the managed care organization's rules and fee schedules in order to be part of the network and agrees not to balance bill patients for amounts beyond the agreed upon fee.
- Browse Related Terms: Exclusive Provider Organization (EPO) Plan, Health Maintenance Organization, Health Maintenance Organization (HMO), In-Network provider, Managed Care, Medicare Advantage, Medicare Advantage (Medicare Part C), Medicare Cost Plans, Medicare Select Plans, Out-of-network provider, Point of Service (POS) Plans, Point-of-Service Plan (POS), Preferred Provider Organization (PPO), Primary Care Physician (PCP), Referral, Third-Party Payer
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If your 2013 income is below $45,950 for an individual or $94,200 for a family of four, your out-of-pocket payment for health services may be lower. If your 2013 income is below $28,725 for an individual or $58,875 for a family of four, you may get extra help to cover your health insurance costs.
- 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 process where expert medical professionals, who have no relationship to your health insurance company or health plan, review specific medical decisions made by the insurance company. California law provides for an Independent Medical Review (IMR) program, which is administered by the CDI or the DMHC depending upon what type of coverage you have (indemnity or HMO).
- 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)
All > Healthcare > Health Insurance
Policies for people that aren't connected to job-based coverage. Individual health insurance policies are regulated under state law.
- Browse Related Terms: Conversion, Family and Medical Leave Act (FMLA), HIPAA Eligible Individual, Individual Health Insurance Policy, Minimum Essential Coverage, Nondiscrimination, Open Enrollment Period, Special Enrollment Period, State Continuation Coverage, Waiting Period (Job-based coverage)
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- A form of health insurance designed to cover just one person (and often immediate family members), as opposed to someone covered by a group plan (see "group health plan").
- 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 requirement that everyone maintain health insurance coverage. The ACA requires that everyone who can purchase health insurance for less than 8 percent of their household income do so or pay a tax penalty.
- 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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Health care that you get when you're admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.
- Browse Related Terms: Acute Care Facility, Assisted Living, Board and Care Facility (Long Term), Hospice Care, Inpatient Care, Long-term Care, Skilled Nursing Care, Skilled Nursing Facility (SNF), Skilled Nursing Facility Care
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A non-profit entity 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.
- 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 companies package and sell insurance plans on the marketplace. One insurance company may offer several different plans with unique costs and benefits.
- An insurance company must be licensed by the Department of Insurance to sell health insurance. The insurer issues policies which outline coverage. An insurance policy is a contract between the insured and the insurance company. You pay your premiums to an insurance company. They then pay some or all of your medical provider's bills when you need treatment (see "provider").
- 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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The charge for the use of borrowed money.
- 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
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All > Healthcare > Health Insurance
The review of the health plan's determination that a requested or provided health care service or treatment health care service is not or was not medically necessary. This review is performed by personnel working at or associated with the health plan. The ACA requires all plans to conduct an internal review upon request of the patient or the patient's representative. Minnesota's internal review process is outlined in Minn. Stat. 62Q.68 through 62Q.72.
- 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)
All > Healthcare > Health Insurance
An agreement between two or more states. The ACA requires the NAIC to develop standards for voluntary interstate compacts that will permit sales of health insurance policies across state lines. These regulations are due July 1, 2013 to permit states to enter into Interstate compacts January 1, 2016. Where there is opportunity for interstate compacts for other insurance products, Minnesota has participated in the Interstate Insurance Product Regulation Compact. (See. Minn. Stat. 62A.99)
- 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 income you get from an investment, like interest you get from a bank or dividends you get from a stock you own.
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