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- A drug sold under a name-brand, and covered by original patents (for example, the name brand for hydrocodone is "Vicodin®"). Name-brand drugs are more expensive than generic drugs, and you usually have a higher co-pay for them than generics (see "generic 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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The organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate.
The mission of the NAIC is to assist state insurance regulators, individually and collectively, in serving the public interest and achieving the following fundamental insurance regulatory goals in a responsive, efficient and cost effective manner, consistent with the wishes of its members:
- Protect the public interest;
- Promote competitive markets;
- Facilitate the fair and equitable treatment of insurance consumers;
- Promote the reliability, solvency and financial solidity of insurance institutions; and
- Support and improve state regulation of insurance.
- Browse Related Terms: Assisters, Consumer Assistance Program, Consumer Assistance Workers, Consumer Support Center, National Association of Insurance Commissioners (NAIC), Navigators, Qualifying Life Event
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An individual or organization that's trained and able to help consumers, small businesses, and their employees as they look for health coverage options through the Marketplace, including completing 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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Navigators deliver in-person outreach, education, and enrollment in both qualified health plans and public insurance options. Consumers can get one-on-one assistance from our statewide network of navigators and assisters.
- Browse Related Terms: Assisters, Consumer Assistance Program, Consumer Assistance Workers, Consumer Support Center, National Association of Insurance Commissioners (NAIC), Navigators, Qualifying Life Event
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The amount by which your total long-term capital gain for the year is more than your short-term capital loss for the year.
- 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)
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The amount someone pays you to use your property, after you subtract the expenses you have for the property. Royalty income includes any payments you get from a patent, a copyright, or some natural resource that you own.
- 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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The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
- 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
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A health plan that contracts with doctors, hospitals, pharmacies, and other health care providers to provide members of the plan with services and supplies at a discounted price.
- 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
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As used in connection with the Affordable Care Act: A health plan that is not a grandfathered health plan and therefore subject to all of the reforms in the Affordable Care Act.
- 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 provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.
A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.
A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider. Check your policy to see if you can go to all providers who have contracted with your health insurance or plan, or if your health insurance or plan has a “tiered” network and you must pay extra to see some providers.
- 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
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A requirement that job-based coverage not discriminate based on health status. Coverage under job-based plans cannot be denied or restricted. You also can't be charged more because of your health status. Job-based plans can restrict coverage based on other factors such as part-time employment that aren't related to health status.
- 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 plan that hasn't been given a "seal of approval" by an independent company to show it meets national quality standards for health plans. There are many reasons why a health plan may not be accredited. For example, some plans have never gone through the accreditation process or have gone through the process with a different accrediting organization. Other plans are too new to be accredited or have started but not finished the accreditation process. Not being accredited doesn't mean that a plan is lower quality than a plan that's accredited.
- Browse Related Terms: Accreditation, Biosimilar Biological Products, Denial, Experimental and/or Investigational Medical Services, Not Yet Accredited (Health Plan), Pre-authorization, Preauthorization, Prior Authorization, Provider
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An official form of communication that informs individuals about the status of their applications, their eligibility for programs, or other important information. Notices may be sent by the Marketplace or by health insurers.
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