Choosing from among insurance options may seem very overwhelming, with a wide array of new choices, coverage and costs. As millions of consumers purchase new coverage through the marketplaces being implemented as part of the Affordable Care Act (ACA) in just a few weeks, it is more important than ever to understand the terms that are commonly used by insurance companies.
Cost Sharing - A feature of health plans where beneficiaries are required to pay a portion of the costs of their care. Examples of costs include co-payments, coinsurance and annual deductibles.
Deductible - A feature of health plans in which consumers are responsible for health care costs up to a specified dollar amount. After the deductible has been paid, the health insurance plan begins to pay for health care services.
Employer-Sponsored Insurance - Insurance coverage provided to employees, and, in some cases, their spouses and children, through an employer.
Essential Health Benefits - A package of benefits set by the Secretary of Health and Human Services that insurers will be required to offer under the exchanges.
Grandfathered Plan - A group health plan that was created or an individual health insurance policy that was purchased on or before March 23, 2010. Grandfathered plans are exempted from many changes required under the Affordable Care Act.
Health Insurance Exchange - A purchasing arrangement through which insurers offer and smaller employers and individuals purchase health insurance. State, regional, or national exchanges could be established to set standards for which benefits would be covered, how much insurers could charge, and the rules insurers must follow in order to participate in the insurance market. Individuals and small employers would select their coverage within this organized arrangement. An example of this arrangement is the Commonwealth Connector, created in Massachusetts in 2006.
Out-Of-Pocket Maximum - A yearly cap on the amount of money individuals are required to pay out-of-pocket for health care costs, excluding the premium cost.
Prior Authorization - Approval from a health plan that may be required before you obtain a service or fill a prescription in order for the service or prescription to be covered by your plan.
Self-Insured Plan - A plan where the employer assumes direct financial responsibility for the costs of enrollees' medical claims. Employer sponsored self-insured plans typically contract with a third-party administrator or insurer to provide administrative services for the plan.
Blood cancer patients and their families can get free, helpful support from The Leukemia & Lymphoma Society's Information Resource Center to speak with a trained information specialist. IRC staff are available Monday through Friday, 9 a.m. to 9 p.m. ET, toll free at (800) 955-4572; email email@example.com; or click the "Live Patient Help" button on the LLS.org homepage.
Note: Unless otherwise indicated, all definitions are from the Health Reform Glossary maintained by the Henry J. Kaiser Family Foundation. The full glossary can be viewed at http://kff.org/glossary/health-reform-glossary/#glossary-a.