Health Insurance terms starting with A

24 terms

  1. Access Fee An ”access fee” is a specific amount that a person covered under the policy must pay each time certain services are used or received.
  2. Accountable Care Organization A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get.
  3. Accreditation If a Marketplace health plan is approved, this is the “seal of approval” given to the plan by an independent organization to show that the plan meets…
  4. Actuarial justification The demonstration by an insurer that the premiums collected are reasonable, given the benefits provided under the plan or that the distribution of…
  5. Actuarial Value The percentage of total average costs for covered benefits that a plan will cover.
  6. Acute Care Facility One step below a hospital, an acute care facility gives advanced medical and nursing services to bring you back to health.
  7. Adjusted community rating A way of pricing insurance where premiums are not based upon a policyholder's health status, but may be based upon other factors, such as age and…
  8. Advanced Premium Tax Credit The Affordable Care Act provides a new tax credit to help you afford health coverage purchased through the Marketplace.
  9. Affordable Care Act The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was…
  10. Affordable Care Act (ACA) This is the title usually given to the federal health reform passed in March 2010 and collectively refers to the provisions of the Patient Protection and…
  11. Affordable coverage (as it relates to APTC) Employer coverage is considered affordable - as it relates to the Advanced Premium Tax Credit (APTC) - if the employee’s share of the annual premium for…
  12. Age Rating Varying premiums based on age. The ACA will cap the maximum variation for age at 3:1.
  13. Agent Agent means any individual, other than a broker-dealer, who represents a broker-dealer or issuer in effecting or attempting to effect purchases or sales…
  14. Alimony Alimony is money you get from a spouse with whom you no longer live, or a former spouse, if paid to you as part of a divorce agreement, separation…
  15. Allowed Amount Maximum amount on which payment is based for covered health care services. This may be called “eligible expense,” “payment allowance" or "negotiated…
  16. Annual Deductible Combined Usually in Health Savings Account (HSA) eligible plans, the total amount that family members on a plan must pay out-of-pocket for health care or…
  17. Annual Household Income The total income for a family in a calendar year.
  18. Annual Limit A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan.
  19. Appeal To call for a review of an IRS decision or proposed adjustment.
  20. Assignment Assignment occurs when someone who has written, or sold, a listed option receives a notice that the option has been exercised and he or she must fulfill…
  21. Assisted Living See board and care facility.
  22. Assisters Assisters deliver in-person outreach, education and enrollment in public insurance coverage options only.
  23. Attest/Attestation When you apply for health coverage through the Marketplace, you're required to agree (or "attest") to the truth of the information provided by signing the…
  24. Authorized Representative Someone who you choose to act on your behalf with the Marketplace, like a family member or other trusted person.