All > Healthcare > Health Insurance
Legislation (Public Law 111-148) signed by President Obama on March 23, 2010. One of two laws collectively referred to as the Affordable Care Act or simply as federal health reform.
- 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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Research that compares different medical treatments and interventions to provide evidence on which strategies are most effective in different populations and situations. The goal is to empower you and your doctor with additional information to make sound health care decisions.
- 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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A payment structure in which different health care providers who are treating you for the same or related conditions are paid an overall sum for taking care of your condition rather than being paid for each individual treatment, test, or procedure. In doing so, providers are rewarded for coordinating care, preventing complications and errors, and reducing unnecessary or duplicative tests and treatments.
- 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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You can choose how often you would like to pay your insurance premiums. If you choose “monthly,” your premium payments will be due every month.
- 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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- See Fee
- 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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All > Healthcare > Health Insurance
A payment or series of payments made to you after you retire from work. Generally, the amount of your income from a pension or retirement account distribution depends on the type of pension or retirement account, how much you contributed to the pension or retirement account, and whether you were already taxed on the amounts you contributed.
- Browse Related Terms: Annual Household Income, Modified adjusted gross income (MAGI), Pension (Retirement Benefit), Retirement Benefit (Pension), Social Security, Social Security Benefits, Social Security Survivors Benefits, Supplemental Security Income (SSI), Tax Household
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Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.
Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.
Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.
- 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
All > Healthcare > Health Insurance
A benefit your employer, union or other group sponsor provides to you to pay for your health care services.
A benefit your employer, union or other group sponsor provides to you to pay for your health care services.
A benefit your employer, union or other group sponsor provides to you to pay for your health care services.
- 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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All > Healthcare > Health Insurance
A 12-month period of benefits coverage under a group health plan. This 12-month period may not be the same as the calendar year. To find out when your plan year begins, you can check your plan documents or ask your employer. (Note: For individual health insurance policies this 12-month period is called a “policy year”).
- Browse Related Terms: Business Day, Calendar Day, Contestability, Grace Period, Mandated benefit, Mandated Health Benefit, Plan Year, Policy Year, Waiting Period
All > Healthcare > Health Insurance
- 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 type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.
- 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
All > Healthcare > Health Insurance
A type of managed care plan combining features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs), in which individuals decide whether to go to a network provider and pay a flat dollar copayment (say $10 for a doctor's visit), or to an out-of-network provider and pay a deductible and/or coinsurance charge.
- 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
All > Healthcare > Health Insurance
The written contract between an individual or group policyholder and an insurance company. The policy outlines the duties, obligations, and responsibilities of both the policyholder and the insurance company. A policy may include any application, endorsement, certificate, or any other document that can describe, limit, or exclude coverage benefits under the policy.
- 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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All > Healthcare > Health Insurance
A 12-month period of benefits coverage under an individual health insurance plan. This 12-month period may not be the same as the calendar year. To find out when your policy year begins, you can check your policy documents or contact your insurer. (Note: In group health plans, this 12-month period is called a “plan year”).
- Browse Related Terms: Business Day, Calendar Day, Contestability, Grace Period, Mandated benefit, Mandated Health Benefit, Plan Year, Policy Year, Waiting Period
All > Healthcare > Health Insurance
The ability to purchase individual health insurance without being denied of coverage because of a pre-existing condition.
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All > Healthcare > Health Insurance
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, except in an emergency. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
Some insurance companies require authorization from them before they will pay for medical services like hospitalization or surgery.
- 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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Any illness or health condition for which you have received medical advice or treatment during the six months prior to obtaining health insurance. Group healthcare policies cover pre-existing conditions after you have been insured for six months, and individual policies cover pre-existing conditions after you have been insured for one year. Reference CIC Section 10198.7. Creditable coverage must be counted towards any pre-existing condition exclusion in either an individual or group policy.
A health problem you had before the date that new health coverage starts.
If you have experienced an illness or disability for which you have been diagnosed, treated or advised, that is considered a “pre-existing condition.” When you apply for an individual health insurance policy, you will be asked to describe any pre-existing conditions or previous treatment. The health insurance carrier may decide to offer you health coverage with an “exclusion” for the specific condition, even if you are not currently experiencing problems. This means the carrier will not cover any medical treatment for the excluded condition. Failing to mention a pre-existing condition for which you have previously sought medical advice is a reason for the carrier to rescind or cancel your policy at a later date. It is always advisable to provide a full and complete medical history.
- 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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All > Healthcare > Health Insurance
Any condition (either physical or mental) including a disability for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period ending on your enrollment date in a health insurance plan. Genetic information, without a diagnosis of a disease or a condition, cannot be treated as a pre-existing condition. Pregnancy cannot be considered a pre-existing condition and newborns, newly adopted children and children placed for adoption who are enrolled within 30 days cannot be subject to pre-existing condition exclusions.
- 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)
All > Healthcare > Health Insurance
The period of time that an individual receives no benefits under a health benefit plan for an illness or medical condition for which an individual received medical advice, diagnosis, care or treatment within a specified period of time prior to the date of enrollment in the health benefit plan. For kids under age 19, the ACA begins to phase-in a prohibition on pre-existing condition exclusions effective September 23, 2010. The ACA will prohibit pre-existing condition exclusions on all plans beginning January 2014.
- 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)