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Abortion services
Accountable care organization
Accreditation
Actuarial value
Adjusted Gross Income (AGI)
Advance premium tax credit (APTC)
Affordability exemption
Affordable Care Act (ACA)
Affordable coverage
Agent and broker (health insurance)
Alimony
Allowed amount
Annual deductible combined
Annual limit
Appeal
Application ID
Attest/Attestation
Authorized representative
Balance billing
Benefit year
Benefits
Biosimilar biological products
Brand name (drugs)
Broker
Bronze health plan
COBRA
Cafeteria plan
Canceled debts
Capital gains
Care coordination
Catastrophic health plan
Centers for Medicare & Medicaid Services (CMS)
Certified application counselor
Children's Health Insurance Program (CHIP)
Chronic disease management
Claim
Co-op
Coinsurance
Community rating
Competitive bidding
Complication of pregnancy
Conversion
Coordination of benefits
Copayment
Cost sharing
Cost sharing reduction (CSR)
Court awards
Creditable coverage
Data matching issue (inconsistency)
Deductible
Dental coverage
Department of Health and Human Services (HHS)
Dependent
Dependent coverage
Disability
Dividend
Domestic partnership
Donut hole (Medicare prescription drug)
Drug list
Durable medical equipment (DME)
Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)
Eligibility assessment
Eligible immigration status
Emergency medical condition
Emergency medical transportation
Emergency room care
Emergency services
Employer or union retiree plans
Employer shared responsibility payment (ESRP)
Essential health benefits
Exchange
Excluded services
Exclusive Provider Organization (EPO) Plan
Exemption
Exemption Certificate Number (ECN)
External review
Family and Medical Leave Act (FMLA)
Federal poverty level (FPL)
Federally Qualified Health Center (FQHC)
Federally recognized tribe
Fee
Fee for service
Flexible Spending Account (FSA)
Flexible benefits plan
Formulary
Full-time employee (FTE)
Fully insured job-based plan
Generic drugs
Gold health plan
Grace period
Grandfathered
Grandfathered health plan
Grievance
Group health plan
Guaranteed issue
Guaranteed renewal
HIPAA eligible individual
Habilitative/Habilitation services
Hardship exemption
Health Insurance Marketplace®
Health Maintenance Organization (HMO)
Health Reimbursement Arrangement (HRA)
Health Savings Account (HSA)
Health care workforce incentive
Health coverage
Health insurance
Health plan categories
Health status
High Deductible Health Plan (HDHP)
High-cost excise tax
High-risk pool plan (state)
Home and community-based services (HCBS)
Home health care
Hospice services
Hospital outpatient care
Hospital readmissions
Hospitalization
Household
In Person Assistance Personnel Program
In-network coinsurance
In-network copayment
Inconsistency (data matching issue)
Individual Coverage Health Reimbursement Arrangement
Individual health insurance policy
Inpatient care
Insurance co-op
Interest
Investment income
Job-based health plan
Large group health plan
Lawfully present
Lifetime limit
Limited cost sharing plan
Long-term care
Marketplace
Medicaid
Medical loss ratio (MLR)
Medical underwriting
Medically necessary
Medicare
Medicare Advantage (Medicare Part C)
Medicare Part D
Medicare hospital insurance tax
Medicare prescription drug donut hole
Member survey results
Minimum essential coverage (MEC)
Minimum value
Modified Adjusted Gross Income (MAGI)
Multi-employer plan
Multi-state plan
Navigator
Net capital gains
Net rental income
Network
Network plan
New plan
Non-preferred provider
Nondiscrimination
Not yet accredited (health plan)
Notice
Open Enrollment Period
Original Medicare
Out-of-network coinsurance
Out-of-network copayment
Out-of-pocket costs
Out-of-pocket estimate
Out-of-pocket maximum/limit
Patient Protection and Affordable Care Act
Patient-centered outcomes research
Payment bundling
Penalty
Pension (retirement benefit)
Physician services
Plan
Plan ID
Plan year
Platinum health plan
Point of Service (POS) Plans
Policy year
Pre-existing Condition Insurance Plan (PCIP)
Pre-existing condition
Pre-existing condition (job-based coverage)
Pre-existing condition exclusion period (individual policy)
Pre-existing condition exclusion period (job-based coverage)
Preauthorization
Preferred Provider Organization (PPO)
Preferred provider
Premium
Premium tax credit
Prescription drug coverage
Prescription drugs
Prevention
Preventive services
Primary care
Primary care physician
Primary care provider
Prior authorization
Public health
QSEHRA
Qualified health plan
Qualifying health coverage
Qualifying life event (QLE)
Quality ratings ("star" ratings)
Rate review
Reconcile
Reconstructive surgery
Referral
Rehabilitative/Rehabilitation services
Reinsurance
Rental or royalty income
Rescission
Retirement benefit (pension)
Rider (exclusionary rider)
Risk adjustment
Same-sex marriage
Second lowest cost Silver plan (SLCSP)
Self-employment income
Self-employment ledger
Self-insured plan
Service area
Silver health plan
Skilled nursing care
Skilled nursing facility care
Small Business Health Options Program (SHOP)
Social Security
Social Security benefits
Social Security survivors benefits
Special Enrollment Period (SEP)
Special health care need
Specialist
Spousal abandonment
Stand-alone dental plan
State Health Insurance Assistance Program (SHIP)
State continuation coverage
State insurance department
State medical assistance office
Subsidized coverage
Summary of Benefits and Coverage (SBC)
Supplemental Security Income (SSI)
TRICARE
TTY
Tax filing requirement
Tax filing requirement (for dependents)
Tax household
Total cost estimate (for health coverage)
Transgender people
UCR (usual, customary, and reasonable)
Uncompensated care
Urban Indian programs
Urgent care

Healthcare Glossary

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