Glossary of Terms A B C D E F G H I J K L M N O P Q R S T U V W X Y ZAAbortion servicesAccountable Care OrganizationAccreditationActuarial ValueAdjusted Gross Income (AGI)Advance Premium Tax Credit (APTC)Affordable Care Act (ACA)Affordable coverageAgent and Broker (Health Insurance)AlimonyAllowed AmountAnnual Deductible CombinedAnnual LimitAppealApplication IDAttest/AttestationAuthorized RepresentativeBBalance BillingBenefit YearBenefitsBiosimilar Biological ProductsBrand Name (Drugs)BrokerBronze Health PlanCCOBRACafeteria PlanCanceled DebtsCapital GainsCare CoordinationCatastrophic Health PlanCenters for Medicare & Medicaid Services (CMS)Certified Application CounselorChildren's Health Insurance Program (CHIP)Chronic Disease ManagementClaimCo-opCoinsuranceCommunity RatingCompetitive BiddingComplication of PregnancyConversionCoordination of BenefitsCopaymentCost SharingCost Sharing Reduction (CSR)Court AwardsCreditable CoverageDData Matching Issue (Inconsistency)DeductibleDental CoverageDepartment of Health and Human Services (HHS)DependentDependent CoverageDisabilityDividendDomestic PartnershipDonut Hole, Medicare Prescription DrugDrug ListDurable Medical Equipment (DME)EEarly and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)Eligibility AssessmentEligible Immigration StatusEmergency Medical ConditionEmergency Medical TransportationEmergency Room CareEmergency ServicesEmployer Shared Responsibility Payment (ESRP)Employer or Union Retiree PlansEssential Health BenefitsExchangeExcluded ServicesExclusive Provider Organization (EPO) PlanExemptionExemption Certificate Number (ECN)External ReviewFFamily and Medical Leave Act (FMLA)Federal Poverty Level (FPL)Federally Qualified Health Center (FQHC)Federally Recognized TribeFeeFee For ServiceFlexible Benefits PlanFlexible Spending Account (FSA)FormularyFull-Time Employee (FTE)Fully Insured Job-based PlanGGeneric DrugsGold Health PlanGrace PeriodGrandfatheredGrandfathered Health PlanGrievanceGroup Health PlanGuaranteed IssueGuaranteed RenewalHHIPAA Eligible IndividualHabilitative/Habilitation ServicesHardship ExemptionHealth Care Workforce IncentiveHealth CoverageHealth InsuranceHealth Insurance Marketplace®Health Maintenance Organization (HMO)Health Plan CategoriesHealth Reimbursement Arrangement (HRA)Health Savings Account (HSA)Health StatusHigh Deductible Health Plan (HDHP)High-Cost Excise TaxHigh-Risk Pool Plan (State)Home Health CareHome and Community-Based Services (HCBS)Hospice ServicesHospital Outpatient CareHospital ReadmissionsHospitalizationHouseholdIIn Person Assistance Personnel ProgramIn-network CoinsuranceIn-network CopaymentInconsistency (Data Matching Issue)Individual Coverage Health Reimbursement ArrangementIndividual Health Insurance PolicyInpatient CareInsurance Co-OpInterestInvestment IncomeJJob-based Health PlanLLarge Group Health PlanLawfully PresentLifetime LimitLimited cost sharing planLong-Term CareMMarketplaceMedicaidMedical Loss Ratio (MLR)Medical UnderwritingMedically NecessaryMedicareMedicare Advantage (Medicare Part C)Medicare Hospital Insurance TaxMedicare Part DMedicare Prescription Drug Donut HoleMember Survey ResultsMinimum Essential Coverage (MEC)Minimum valueModified Adjusted Gross Income (MAGI)Multi-Employer PlanMulti-State PlanNNavigatorNet Capital GainsNet Rental IncomeNetworkNetwork PlanNew PlanNon-preferred providerNondiscriminationNot Yet Accredited (Health Plan)NoticeOObamacareOpen Enrollment PeriodOriginal MedicareOut-of-Network CoinsuranceOut-of-Network CopaymentOut-of-Pocket CostsOut-of-Pocket EstimateOut-of-pocket maximum/limitPPatient Protection and Affordable Care ActPatient-Centered Outcomes ResearchPayment BundlingPenaltyPension (Retirement Benefit)Physician ServicesPlanPlan IDPlan YearPlatinum Health PlanPoint of Service (POS) PlansPolicy YearPre-Existing ConditionPre-Existing Condition (Job-based Coverage)Pre-Existing Condition Exclusion Period (Individual Policy)Pre-Existing Condition Exclusion Period (Job-based Coverage)Pre-existing Condition Insurance Plan (PCIP)PreauthorizationPreferred ProviderPreferred Provider Organization (PPO)PremiumPremium Tax CreditPrescription Drug CoveragePrescription DrugsPreventionPreventive ServicesPrimary CarePrimary Care PhysicianPrimary Care ProviderPrior AuthorizationPublic HealthQQSEHRAQualified Health PlanQualifying Health CoverageQualifying Life Event (QLE)Quality Ratings (or 'star' ratings)RRate ReviewReconcileReconstructive SurgeryReferralRehabilitative/Rehabilitation ServicesReinsuranceRental or Royalty IncomeRescissionRetirement Benefit (Pension)Rider (exclusionary rider)Risk AdjustmentSSame-Sex MarriageSecond lowest cost Silver plan (SLCSP)Self-Employment IncomeSelf-Employment LedgerSelf-Insured PlanService AreaSilver Health PlanSkilled Nursing CareSkilled Nursing Facility CareSmall Business Health Options Program (SHOP)Social SecuritySocial Security BenefitsSocial Security Survivors BenefitsSpecial Enrollment Period (SEP)Special Health Care NeedSpecialistSpousal AbandonmentStand-alone dental planState Continuation CoverageState Health Insurance Assistance Program (SHIP)State Insurance DepartmentState Medical Assistance OfficeSubsidized CoverageSummary of Benefits and Coverage (SBC)Supplemental Security Income (SSI)TTRICARETTYTax HouseholdTax filing requirementTax filing requirement (for dependents)Total Cost Estimate (for health coverage)Transgender PeopleUUCR (Usual, Customary, and Reasonable)Uncompensated CareUrban Indian programsUrgent CareVValue-Based Purchasing (VBP)Vision CoverageWWaiting Period (Job-based coverage)Well-baby and Well-child VisitsWellness ProgramsWorker's CompensationZZero cost sharing plan
