Glossary

Affordable Care Act Glossary of Terms

To help you better understand some of the terminology associated with the Affordable Care Act, we have listed a glossary of a few terms with their definition.

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Affordable Care Act (ACA):

Health Care Reform Law passed March 23, 2010

Coinsurance:

The percentage of charges you pay for health services after the annual deductible. Coinsurance amounts do vary from plan to plan and the type of service needed.

Copayment:

The flat dollar amount you pay at the time you receive certain health services and prescription drugs. Copayments vary from plan to plan and the type of service you need and are not subject to the deductible.

Deductible:

The flat dollar amount you must pay before your health plan begins to pay for services rendered. Deductibles can be based upon a calendar year (January 1 – December 31) or contract year (August 1, 2013 - July 31, 2014, for example).

Grandfathered Plans:

A group health plan that was created, or an individual plan that was purchased, on or before March 23, 2010. Grandfathered plans are exempt from some of the changes required by the ACA.

Health Care Reform:

The general term for the policy changes under the Affordable Care Act.

Health Insurance Marketplace:

Government run, online markets where individuals and small businesses can shop and enroll in health plans. Additional services offered will be answers to questions, financial assistance and special programs.

The Marketplace:

See HEALTH INSURANCE MARKETPLACE

Network:

FHCP contracted providers, facilities and pharmacies you have access to as an enrolled member with FHCP.

Out-of-Network:

The providers, facilities and pharmacies that FHCP does not have a contract with. Under certain plans (i.e., POS and Triple Option), you may still see these uncontracted providers. However, the out of pocket costs will be higher.

Maximum Out of Pocket Expenses:

The total dollar amount you will pay per calendar or contract year. This amount can include copayments, coinsurance and deductible payments you have paid for services. It does not include the monthly premium you pay each month for coverage.

Pre-Existing Condition:

Any medical condition that you have received treatment for prior to enrolling in a new health insurance policy.

Premium:

The dollar amount you pay each month for your health care coverage. This amount can be paid to your employer if you have group insurance or FHCP directly if you have individual coverage.

Preventative Care:

These are covered services to keep you healthy and to prevent illness. Examples include annual check-ups and tests, immunizations and vaccines.

Provider:

A health care professional or facility that is licensed, certified or accredited to provide you with care and services, as required by Florida State law.

Small Employer Group:

An employer with less than 50 full-time employees.

Summary of Benefits and Coverage (SBC):

In accordance with the ACA, every insurer must supply this document as well as a uniform glossary of terms to members and prospective members during open enrollment or upon request.

Subsidy:

For those that qualify, financial assistance from the government to assist with payment of health coverage. The government will pay this subsidy directly to the health plan chosen by the individual. The amount is determined upon many factors, including family size and
income level.

Page Last Updated: 8/02/13