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Health Insurance Glossary
Actuarial Value
Agent (Health insurance agent)
Allowable Charge
Authorized Representative
Benefit Period (Benefit Year)
Benefits (Medical service or supply)
Biosimilars
Broker (Health insurance broker)
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Catastrophic Insurance
Claim (Health insurance claim)
Coinsurance
Coordinated Care
Copay (Medical or health-related expense)
Cost-Sharing Reduction (CSR)
Deductible
Department of Health and Human Services (HHS)
Dependent (Spouses or children)
Disability Insurance
Effective Date
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Employee Contribution
Employer Contribution
Excluded Services (Medical Exclusions)
Exclusive Provider Organization (EPO)
Exemption Certificate Number (ECN)
Family Medical Leave Act (FMLA)
Flexible Benefit Plan
Flexible Spending Account (FSA)
Formulary (Drug Formulary)
Generic Drugs
Grace Period
Group Health Plan (Group Health Insurance)
Guaranteed Issue
Guaranteed Renewable
HIPAA (Health Insurance Portability and Accountability Act)
HMO (Health Maintenance Organization)
Habilitation Services
Health Insurance Marketplace (Exchange)
Health Reimbursement Account (HRA)
Health Savings Account (HSA)
Healthcare Provider
High-Risk Pools
Household Income
Individual Mandate
Inpatient Care
Large Group Health Plan
Long Term Care
Major Medical (Minimum Essential Coverage)
Maternity Coverage
Medicaid (federally subsidized health coverage)
Medical Loss Ratio (MLR)
Medical Underwriting
Medicare (federally funded health insurance program )
Metal Levels
Navigators
Obamacare (Affordable Care Act)
Open Enrollment Period (OEP)
Out-of-Pocket
Outpatient Care
PPO (Preferred Provider Organization)
Point of Service (POS)
Pre-Existing Condition
Preferred Provider
Premium (Health insurance premiums)
Premium Tax Credit (Government Tax Subsidy)
Prescription Drugs
Preventive Services
Primary Care
Primary Care Physician
Provider Network
Qualified Health Plans (QHP)
Qualifying Life Event (QLE)
Quality Rating (Star Rating)
Rehabilitation Services
Reinsurance (Stop-Loss Insurance)
Rescission
Rider (Amendments, or changes, to your health insurance policy)
Risk Adjustment
Service Area
Short Term
Special Enrollment Period (SEP)
Specialist (Medical Specialist)
Spousal Abandonment
Stand-Alone Dental Plan
State Continuation Coverage
State Insurance Department
Summary of Benefits and Coverage (SBC)
Tax Filing Limit
Tax Penalty
Teletypewriter (TTY)
Total Cost Estimate
Uncompensated Care
Underwriting
Urgent Care
Usual Customary and Reasonable (UCR)
Value-Based Purchasing (VBP)
Vision Coverage
Waiting Period
Wellness Programs

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