obamacarequote.com

Serving ACA (Obama Care) in Texas, Mississippi, Florida, and Georgia

obamaCare

Glossary

A

Accountable care organization (ACO): A group of health care providers who give coordinated care and chronic disease management and thereby improve the quality of care patients get. The organization’s payment is tied to achieving healthcare quality goals and outcomes that result in cost savings.

Actuarial value: A health insurance plan’s actuarial value is the percentage of total average costs for benefits that a plan covers. All Obama Care Quotes health insurance plans have an actuarial value assigned to them: Bronze, Silver, Gold, or Platinum. As the metal category increases in value, so does the percent of medical expenses that a health plan covers. This means the Platinum plans cover the highest percentage of health care expenses. These expenses are usually incurred at the time of health care services — when you visit the doctor or the emergency room, for example. The health insurance plans that cover the greatest percentage of health care expenses also usually have higher premium payments.

Advanced Premium Tax Credit (APTC): Financial assistance eligible consumers may receive when enrolling in an Obama Care Quotes health insurance plan to assist them in paying their monthly premium costs. The amount of premium assistance an individual may receive is determined based on his or her income as a percentage of the federal poverty level. This tax credit may also be described as “premium assistance.” Tax credits are also available to small businesses with fewer than 25 full-time-equivalent employees to help offset the cost of providing coverage.

Affordable Care Act: Enacted in March 2010, the federal Patient Protection and Affordable Care Act (Affordable Care Act), occasionally referred to as “Obamacare,” provides the framework, policies, regulations, and guidelines for implementing comprehensive health care reform by the states. The Affordable Care Act expands access to quality, affordable insurance and health care.

Affordable coverage: Employer coverage is considered affordable — as it relates to premium assistance from the federal government (also known as the Advanced Premium Tax Credit [APTC]) — if the employee’s share of the annual premium for self-only coverage is no greater than a certain percentage of annual household income. Individuals offered employer-sponsored coverage that’s affordable and provides minimum value are not eligible for premium assistance.

Allowed amount: The amount a health insurance plan and health care provider have agreed on as reimbursement for a service by contract. For example, the provider agrees to accept a set dollar amount as full payment for an office visit.

Ambulatory patient services: Medical care provided without needing admission to a health care facility. This includes a range of medical procedures and treatments such as blood tests, X-rays, vaccinations, and even monthly well-baby checkups by pediatricians.

Annual household income: The total amount of income for a family in a calendar year. The modified adjusted gross income of the household is used for tax purposes.

Annual limit: A cap on the benefits your insurance company will pay in a year while enrolled in a particular health insurance plan. These caps are sometimes placed on particular services, such as prescriptions or hospitalizations. Annual limits may be placed on the dollar amount of covered services or the number of visits that will be covered for a particular service. After an annual limit is reached, you must pay all associated healthcare costs for the rest of the year.


B

Benefit: Products and services covered under health insurance plans. Covered benefits and excluded services are defined in the insurance products’ explanations of coverage.

Bronze plan: Obama Care Quotes health insurance plans — and all health plans in the individual and small-group markets — are sold in four levels of coverage: Bronze, Silver, Gold, and Platinum. As the metal category increases in value, so does the percentage of medical expenses that a health insurance plan covers compared with what you are expected to pay in co-pays and deductibles. On average, Platinum-level plans cover 90 percent of health care costs, and you pay 10 percent; Gold plans cover 80 percent, while you pay 20 percent; Silver plans cover 70 percent, while you pay 30 percent; and Bronze plans cover 60 percent, while you pay 40 percent.

Plans in higher metal categories have higher monthly premiums, but when you need medical care, you pay less. Alternatively, you can choose to pay a lower monthly premium, and when you need medical care, you pay more. You can choose the level of coverage that best meets your health needs and budget.


C

Carrier: A company that provides health insurance plans.

Certified Insurance Agent: Insurance agents wishing to work with Obama Care Quotes must possess a valid license through the Texas, Mississippi, Georgia, and Florida Department of Insurance and must complete Obama Care Quotes ‘s Certified Insurance Agent training and certification program.

Obama Care Quotes  Certified Insurance Agents assist consumers in receiving eligibility determinations. Agents also work one-on-one with consumers to help them complete the Obama Care Quotes application and select and enroll in a health insurance plan in either Obama Care Quotes ‘s individual market. Unlike Certified Enrollment Counselors, Certified Insurance Agents may collect premiums for consumers who are enrolled electronically, but they are prohibited from collecting any premium payments on behalf of consumers who complete the paper application. Certified Insurance Agents provide impartial information about a consumer’s plan choices, and they can offer advice about which particular plan may best meet a consumer’s needs.

COBRA: A federal law (the Consolidated Omnibus Budget Reconciliation Act) that may allow you to keep health coverage after your employment ends temporarily, you lose coverage as a dependent of the covered employee, or another qualifying event. If you elect COBRA coverage, you pay 100 percent of the premiums, including the share the employer used to pay, plus a small administrative fee.

Coinsurance: Your share of the costs of a covered healthcare service is calculated as a percentage (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductible you owe. For example, if the health insurance plan’s allowed amount for an office visit is $100, and you have met your deductible for the year, your coinsurance payment of 20 percent would be $20. The health plan pays the rest of the allowed amount.

Copayment: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

Cost-sharing: The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, coinsurance and, copayments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services. Cost-sharing in Medicaid and Children’s Health Insurance Program also includes premiums.


D

Deductible: The amount you owe for health care services your health insurance plan covers before your plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you have met your deductible for covered health care services. The deductible may not apply to all services.

Dental coverage: Benefits that help pay for the cost of visits to a dentist for basic or preventive services, like teeth cleaning, X-rays, and fillings.

Dental Exclusive Provider Organization (DEPO): A dental exclusive provider organization (DEPO) works like a dental preferred provider organization (DPPO) but does not provide coverage for services provided by dentists outside the network of participating providers.

Dental Preferred Provider Organization (DPPO): A type of dental plan product that delivers dental services to members through a network of contracted dental care providers and includes limited coverage of out-of-network services.

Dental Health Maintenance Organization (DHMO): A type of dental plan product that delivers dental services by requiring assignment to a primary dental care provider who is paid a per-patient fee for providing all required dental services to the enrollee unless specialty care is needed. Dental health maintenance organizations (DHMOs) require referral to specialty dental providers. These products do not cover services provided by dental care providers outside the dental plan.

Dependent: A child or other individual for whom a parent, relative, or other person may claim a personal exemption tax deduction. Under the Patient Protection and Affordable Care Act, individuals can get premium assistance to help cover the cost of coverage for themselves and their dependents.

Dependent (for Shared Responsibility provision): For purposes of the Employer Shared Responsibility provisions, a dependent is an employee’s child (including a child who has been legally adopted or placed for adoption) who has not reached the age of 26. Spouses are not considered dependents, and neither are stepchildren or foster children. For more information, see:https://www.irs.gov/Affordable-Care-Act/Employers/Employer-Shared-Responsibility-Provisions

Dependent Coverage: Insurance coverage for family members of the policyholder, such as spouses, children, or partners.


E

Emergency Services: Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.

ESRP – Employer Shared Responsibility provisions: Under the Affordable Care Act’s Employer Shared Responsibility provisions, ALEs must either offer minimum essential coverage that is “affordable” and that provides “minimum value” to their full-time employees (and their dependents) or potentially make an employer shared responsibility payment to the IRS. The Employer Shared Responsibility provisions are sometimes called “the employer mandate” or “the pay or play provisions.” Most employers will fall below the ALE threshold number of employees and, therefore, will not be subject to the Employer Shared Responsibility provisions. For more information, see: https://www.irs.gov/Affordable-Care-Act/Employers/Employer-Shared-Responsibility-Provisions.

Essential Health Benefits: Healthcare service categories that must be covered by all plans, starting in 2014. These service categories include ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; behavioral health treatment; prescription drugs; rehabilitation and habilitation services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including dental and vision care. Insurance policies must cover these benefits in order to be certified and offered in the marketplace.

Exchange: See “health insurance marketplace.”

Exclusive Provider Organization (EPO): An exclusive provider organization (EPO) is a type of health care doctor and hospital network that offers a full array of covered benefits from a single network. Covered benefits are not paid for services rendered by a doctor or hospital that is not part of the network, except in the case of emergency or plan-approved care outside the network.


F

Federal Poverty Level: A measure of income level issued annually by the U.S. Department of Health and Human Services. Federal poverty levels are used to determine eligibility for specific programs and benefits.

Federally Recognized Tribe: Any American Indian or Alaska Native tribe, band, nation, pueblo, village, or community that the U.S. Department of the Interior acknowledges to exist as an American Indian tribe.

Formulary: A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Full-Time Employees: For the purposes of the Employer Shared Responsibility provisions, a full-time employee for any calendar month is an employee who has, on average, at least 30 hours of service per week during the calendar month or at least 130 hours of service during the calendar month. For more information, see: https://www.irs.gov/Affordable-Care-Act/Employers/Identifying-Full-time-Employees

Full-Time Equivalent Employee – FTE: For purposes of determining whether the employer is an Applicable Large Employer (ALE), an employer determines its number of full-time-equivalent employees for a month in the steps that follow: 

Combine the number of service hours of all non-full-time employees (e.g. part-time employees or those working fewer than 30 hours per week) for the month but do not include more than 120 hours of service per employee, and divide the total by 120. The resulting number is the number of full-time equivalent employees for a month. This figure should be combined with the number of full-time employees to get a total employment figure for a month. The employment figure for each calendar month will be used to determine the employer’s ALE status for the calendar year.

An ALE need not offer minimum essential coverage to its part-time employees to avoid an employer-shared responsibility payment. A part-time employee’s receipt of the premium tax credit for purchasing coverage through the Marketplace cannot trigger an employer-shared responsibility payment.

For more information, see: https://www.irs.gov/Affordable-Care-Act/Employers/Determining-if-an-Employer-is-an-Applicable-Large-Employer

For more information see: https://www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit-Questions-and-Answers:-Determining-FTEs-and-Average-Annual-Wages


G

Gold plan: Obama Care Quotes health insurance plans — and all health plans in the individual and small-group markets — are sold in four levels of coverage: Bronze, Silver, Gold, and Platinum. As the metal category increases in value, so does the percentage of medical expenses that a health plan covers compared with what you are expected to pay in co-pays and deductibles. On average, Platinum-level plans cover 90 percent of health care costs, and you pay 10 percent; Gold plans cover 80 percent, while you pay 20 percent; Silver plans cover 70 percent, while you pay 30 percent; and Bronze plans cover 60 percent, while you pay 40 percent.

Plans in higher metal categories have higher monthly premiums, but when you need medical care, you pay less. Alternatively, you can pay a lower monthly premium, and when you need medical care, you pay more. You can choose the level of coverage that best meets your health needs and budget.

Guaranteed Issue: A requirement that health insurance plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health services.


H

Habilitative Services/Habilitation Services: Health care services that help you keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in various inpatient and outpatient settings.

Health Care Service Plan (HCSP): A health care service plan (HCSP) is a type of health care doctor and hospital network that offers a full array of covered benefits from a single network. Covered benefits are not paid for services rendered by a doctor or hospital not part of the network, except in the case of emergency or plan-approved care outside the network.

Health Coverage: Legal entitlement to payment or reimbursement for your health care costs, generally under a contract with a health insurance company; a group health plan offered in connection with employment; or a government program like Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

Health Disparities: Preventable differences in health status among different groups of people. These groups may be based on race, ethnicity, immigrant status, disability, sex or gender, sexual orientation, geography, and income. Because the health status of a population is influenced by social factors such as geography, income, and race/ethnicity, these factors affect the prevalence of disease and life expectancy.

Health Insurance: A contract that requires your health insurer to pay some or all of your health care costs in exchange for a premium.

Health Insurance Marketplaces: Under the Patient Protection and Affordable Care Act, these are resources where individuals, families, and small businesses can learn about their health coverage options, compare health insurance plans based on costs, benefits, and other important features, choose a plan, and enroll in coverage. Marketplaces also provide information on programs that help people with low to moderate income and resources pay for coverage. This includes ways to save on the monthly premiums and out-of-pocket coverage costs available through the marketplaces and information about other programs, including Medicaid and the Children’s Health Insurance Program (CHIP). Marketplaces encourage competition among private health plans and are accessible through websites, call centers, and in-person assistance.

Health Insurance Plan: See “health insurance.”

Health insurance plans sold through Obama Care Quotes, the state’s marketplace for the federal Patient Protection and Affordable Care Act, provide essential health benefits, follow established limits on cost-sharing (such as for deductibles, copayments, and out-of-pocket maximum amounts), and meet other requirements of the federal health care law.

Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the health maintenance organization (HMO). It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.

Health Risk Assessment: Sometimes called health assessment or health risk appraisal, health risk assessment is a tool, usually a questionnaire, used by a member to provide information about their health status and risk factors for disease. Members’ medical providers can use their completed health risk assessment to provide personalized feedback, including ways to reduce a member’s risk of disease.

Hospitalization: Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care.


I

Independent Practice Association (IPA): An independent practice association (IPA) is a legal entity organized and directed by physicians in private practice to negotiate contracts with health insurance issuers on their behalf.

Inpatient care: Health care that you get when you’re admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.

Investment Income: The income you get from an investment, like interest you get from a bank or dividends you get from a stock you own. For more information, see the Internal Revenue Service’s Publication 550.


J

Job-Based Health Plan: Coverage that is offered to an employee (and often his or her family) by an employer.


L


M

Marketplace: See “health insurance marketplace.”

Medically Necessary: Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.

Medicare: A federal health insurance program for people aged 65 or older and specifically younger people with disabilities. It also covers people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

Minimum Coverage Plan: Obama Care Quotes health insurance plans — and all health plans in the individual and small-group markets — are sold in four levels of coverage: Bronze, Silver, Gold, and Platinum. In addition to these categories, Obama Care Quotes offers a “minimum coverage plan,” also known as a “catastrophic plan,” which helps protect a person from financial disaster in the event of a severe and expensive medical emergency. Minimum coverage plans are designed to cover excessive medical bills that occur above the limit you can manage financially. Obama Care Quotes offers minimum coverage to those up to age 30 or those individuals who prove they are without affordable coverage options or are experiencing financial hardship.

MEC – Minimum Essential Coverage: Coverage that, under the regulations, provides affordable minimum coverage and provides minimum value to its full-time employees (and their dependents). Minimum essential coverage designated by statute or regulations includes the following:

  • Employer-sponsored coverage (including Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage and retiree coverage)
  • Coverage purchased in the individual market, including a qualified health plan offered by the Health Insurance Marketplace (such as Obama Care Quotes )
  • Medicare Part A coverage and Medicare Advantage (MA) plans
  • Most Medicaid coverage
  • Children’s Health Insurance Program (CHIP) coverage
  • Certain types of veterans’ health coverage administered by the Veterans Administration
  • TRICARE
  • Coverage provided to Peace Corps volunteers
  • Coverage under the Non-appropriated Fund Health Benefit Program
  • Refugee Medical Assistance supported by the Administration for Children and Families
  • Self-funded health coverage offered to students by universities for plan or policy years that begin on or before Dec. 31, 2014 (for later plan or policy years, sponsors of these programs may apply to HHS to be recognized as minimum essential coverage)
  • State high-risk pool coverage established on or before November 26, 2014, in any state

For more information, see: https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/minimum-essential-coverage.html
and https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/ACA-Individual-Shared-Responsibility-Provision-Minimum-Essential-Coverage.

Minimum Value: An employer-sponsored plan provides minimum value if it covers at least 60 percent of the total allowed cost of benefits that are expected to be incurred under the plan. https://www.irs.gov/Affordable-Care-Act/Employers/Minimum-Value-and-Affordability


N

Network: The facilities, providers, and suppliers your health insurer or plan has contracted to provide health care services.


O

Offer of Coverage: An employer offers coverage to an employee if it provides the employee an adequate opportunity to enroll in the health coverage (or to decline that coverage) at least once for each plan year. An employer offers health coverage to an employee for the plan year if it continues the employee’s election of coverage from a prior year but provides the employee an adequate opportunity to opt out of the health coverage.

Suppose an employer provides health coverage to an employee but does not provide the employee an effective opportunity to decline the coverage. In that case, the employer is treated as having made an offer of health coverage to the employee only if that health coverage provides minimum value and does not require an employee contribution for the coverage for any calendar month of more than 9.56 percent in 2018 of a monthly amount determined as the mainland federal poverty line for a single individual for the applicable calendar year, divided by 12.

For more information: https://www.irs.gov/pub/irs-prior/i109495c–2015.pdf and https://www.irs.gov/pub/irs-drop/n-15-87.pdf

Open Enrollment: A designated period of time each year during which individuals or employees can enroll in a health insurance plan or make changes to their coverage. Open enrollment for Obama Care Quotes takes place during the fall.

People who experience certain life events — such as getting married or losing previous health coverage — may be eligible for special enrollment outside of the open enrollment period. See “special enrollment.”  enrollment occurs year-round.

Out-Of-Pocket Costs: An out-of-pocket expense is a nonreimbursable expense a patient pays. This could include any medical benefits that a plan doesn’t consider “covered services.”

Out-Of-Pocket Limit: The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100 percent of the allowed amount. This limit never includes your premium, balance-billed charges, or health care your health insurance plan doesn’t cover. Some health insurance plans don’t count all of your copayments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit. In Medicaid and Children’s Health Insurance Program, the limit includes premiums.


P

Patient Protection and Affordable Care Act: Enacted in March 2010, the federal Patient Protection and Affordable Care Act (Affordable Care Act), occasionally referred to as “Obamacare,” provides the framework, policies, regulations, and guidelines for implementation of comprehensive healthcare reform by the states. The Affordable Care Act expands access to quality, affordable insurance and health care.

Platinum plan: Obama Care Quotes health insurance plans — and all health plans in the individual and small-group markets — are sold in four levels of coverage: Bronze, Silver, Gold, and Platinum. As the metal category increases in value, so does the percentage of medical expenses that a health insurance plan covers compared with what you are expected to pay in co-pays and deductibles. On average, Platinum-level plans cover 90 percent of health care costs, and you pay 10 percent; Gold plans cover 80 percent, while you pay 20 percent; Silver plans cover 70 percent, while you pay 30 percent; and Bronze plans cover 60 percent, while you pay 40 percent.
Plans in higher metal categories have higher monthly premiums, but when you need medical care, you pay less. Alternatively, you can choose to pay a lower monthly premium, and when you need medical care, you pay more. You can choose the level of coverage that best meets your health needs and budget.

Policy: The contract (agreement) between the person buying health insurance and the company providing it describes specific health care services that are covered, any coverage limitations, and any out-of-pocket costs (copays) that might be required.

Pre-existing medical condition: Any illness or condition a patient has prior to obtaining insurance.

Preferred Provider: A provider who has a contract with your health insurer or plans to provide services to you at a discount. Check your policy to see if you can see all preferred providers or if your health insurance or plan has a “tiered” network, and you must pay extra to see some providers. Your health insurance or plan may have preferred providers who are also “participating” providers. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more.

Pre-Existing Medical Condition: Any illness or condition a patient has prior to obtaining insurance.

Preferred Provider Organization (PPO): A type of health insurance plan that contracts with participating doctors and hospitals to create a network. You pay less using doctors and hospitals in the plan’s network. You can use doctors, hospitals, and others outside the network for an additional cost.

Premium: The amount that must be paid for your health insurance or plan. You or your employer, or both, usually pay it monthly, quarterly, or yearly.

Premium Assistance: See “Advanced Premium Tax Credit.”

Premium Tax Credit – PTC: The premium tax credit, or PTC, is a refundable tax credit calculated by filing a Tax Return that helps eligible individuals and families with low or moderate income afford health insurance purchased through a Health Insurance Marketplace such as Obama Care Quotes. To get this credit, the employee must meet specific requirements and file a tax return. For more information, see: https://www.irs.gov/Affordable-Care-Act/Individuals-and-Families/The-Premium-Tax-Credit

Preventive Services/Preventive Care: Routine health care includes screenings, checkups, and patient counseling to prevent illnesses, diseases, or other health problems.

Primary Care Provider: A physician (medical doctor [M.D.] or doctor of osteopathic medicine [D.O.]), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health care services.


Q

Qualified Health Plan (QHP): An insurance product that is certified by a marketplace provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements. A qualified health plan is certified by each marketplace in which it is sold. All Obama Care Quotes health insurance plans are qualified health plans.

Qualifying Life Event: A change in your life that can make you eligible for a particular enrollment period to enroll in health coverage. Examples of qualifying life events are moving to a new state, specific changes in your income, and changes in your family size (for example, if you marry, divorce, or have a baby).


R

Rehabilitative/Rehabilitation Services: Health care services that help you keep, get back, or improve skills and functioning for daily living that have been lost or impaired because you were sick, hurt, or disabled. These services may include physical and occupational therapy, speech-language pathology, and psychiatric rehabilitation services in various inpatient and outpatient settings.

Risk Adjustment: A statistical process that considers the underlying health status and health spending of the enrollees in an insurance plan when looking at their health care outcomes or health care costs.


S

Seasonal Worker: Seasonal workers are workers who perform labor or services on a seasonal basis as defined by the Secretary of Labor, and retail workers are employed exclusively during holiday seasons. For this purpose, employers may apply a reasonable, good-faith interpretation of the term “seasonal worker.” For more information, see: https://www.irs.gov/Affordable-Care-Act/Employers/Determining-if-an-Employer-is-an-Applicable-Large-Employer

Service Center Representative: Obama Care Quotes Service Center representatives work in one of Obama Care Quotes’ regional Service Centers. Service Center representatives are trained employees who guide Californians through their individual health coverage options in the marketplace and help them determine whether they qualify for federal financial assistance to cover some costs.

Silver plan: Obama Care Quotes health insurance plans — and all health plans in the individual and small-group markets — are sold in four levels of coverage: Bronze, Silver, Gold, and Platinum. As the metal category increases in value, so does the percentage of medical expenses that a health plan covers compared with what you are expected to pay in co-pays and deductibles. On average, Platinum-level plans cover 90 percent of health care costs, and you pay 10 percent; Gold plans cover 80 percent, while you pay 20 percent; Silver plans cover 70 percent, while you pay 30 percent; and Bronze plans cover 60 percent, while you pay 40 percent.

Plans in higher metal categories have higher monthly premiums, but when you need medical care, you pay less. Alternatively, you can choose to pay a lower monthly premium, and when you need medical care, you pay more. You can choose the level of coverage that best meets your health needs and budget.

Special Enrollment: The opportunity for people who experience a life-changing event, such as the loss of a job, death of a spouse, or birth of a child, to sign up immediately for a health plan, even if it is outside the plan’s specified enrollment period.

Subsidy: Cost-sharing subsidies and premium assistance reduce the cost of premiums and out-of-pocket expenses for health coverage that qualifying individuals and families purchase through Obama Care Quotes.

Summary of benefits and coverage (SBC): An easy-to-read summary that compares costs and coverage between health plans. You can compare options based on price, benefits, and other features that may be important to you. You’ll get a summary of benefits and coverage (SBC) when you shop for coverage on your own or through your job, renew or change coverage, or request an SBC from the health insurance company.


T

Tax Credit: See “Advanced Premium Tax Credit.”

Tax Household: The taxpayer(s) and any individuals claimed as dependents on one federal income tax return. A tax household may include a spouse or dependents.

Tax Penalty: There are penalties for individuals who choose not to get affordable insurance. These penalties are part of the federal law and will be collected by the Internal Revenue Service as part of individual tax filing for 2014. There are no penalties for small employers (fewer than 50 full-time-equivalent employees), but starting in 2015, large employers may be penalized if they do not offer affordable coverage to their employees.

Team Care: Also called team-based care, team care is based on a philosophy of professional and nonprofessional personnel who work together toward a common goal of providing quality, comprehensive care. The team members may include nurses, physician assistants, pharmacists, nutritionists, social workers, and care coordinators.

Telehealth: Also called telemedicine, telehealth is the use of telecommunication and information technology that allows medical providers to evaluate, diagnose, and treat patients in real-time, at a distance. Telehealth includes applications and services using two-way video, email, smartphones, wireless tools, and other forms of telecommunications.


U

Urgent Care: Care for an illness, injury, or condition serious enough that a reasonable person would seek care immediately but not so severely as requiring emergency room care.


W

Well-Baby And Well-Child Visits: Routine doctor visits for comprehensive preventive health services occur when a baby is young, and annual visits until a child reaches age 21. Services include physical exams and measurements, vision and hearing screening, and oral health risk assessments.

Was this article helpful?

Need Support?

Can't find the answer you're looking for?
Contact Support
Spanish »