CCHI - Insurance.pdf CCHI - Insurance.pdf CCHI - Insurance.pdf
CCHI - Insurance
Affordable Care Act (ACA)/ Health Care Reform; Obamacare - ANSWER-The comprehensive
federal health care reform law enacted in March 2010.
Health Insurance - ANSWER-A contract that requires an individual's health insurer to pay some
or all of their health care costs in exchange for a premium.
Health Insurance Marketplace/ Exchange - ANSWER-State- or federally run and regulated
market where an individual can shop, compare, and buy health care coverage.
Eligibility requirements - ANSWER-Conditions that must be met in order for an individual or
group to be considered eligible for insurance coverage.
Open enrollment (period) - ANSWER-A period of time each year when an individual can
purchase or change health coverage.
Medicaid - ANSWER-Health insurance provided by the government to some low-income people,
families and children, pregnant women, the elderly, and people with disabilities. In some states
the program covers all adults below a certain income level. Medicaid programs must follow
federal guidelines, but coverage and costs may be different from state to state.
Children's Health Insurance Program (CHIP) - ANSWER-Health insurance provided by the
government to children in families that earn too much money to qualify for Medicaid. In some
states, CHIP covers parents and pregnant women. Each state works closely with its state
Medicaid program. In many cases, if an individual qualifies for Medicaid your children will qualify
for either Medicaid or CHIP.
Medicare - ANSWER-A federal health insurance program, administered by the Social Security
Administration, that provides health care for most people over 65 and certain other eligible
individuals.
Health plan - ANSWER-A benefit an individual's employer, union or other group sponsor
provides to that individual to pay for their health care services.
Secondary coverage - ANSWER-When a person is covered under more than one health
insurance plan, this term describes the health insurance plan that provides payment on claims
after the primary coverage (i.e. main plan).
Managed care - ANSWER-A general term used to describe a variety of health care and health
insurance systems that attempt to guide a patient's use of benefits, typically by requiring that a
CCHI - Insurance.pdf CCHI - Insurance.pdf CCHI - Insurance.pdf
, CCHI - Insurance.pdf CCHI - Insurance.pdf CCHI - Insurance.pdf
patient coordinate his or her health care through a primary care physician, or by encouraging
the use of a specific network of healthcare providers. The management of health care is
intended to keep costs -and monthly premiums- as low as possible. Examples of managed care
plans include:
• Health maintenance organizations (HMOs),
• Preferred provider organizations (PPOs),
• Exclusive provider organizations (EPOs), and
• Point of service plans (POSs).
Premium - ANSWER-The amount that must be paid for an individual's health insurance or plan.
The individual and/or their employer usually pay it monthly, quarterly or yearly.
Dependent - ANSWER-A spouse, child, or domestic partner who is covered under a
policyholder or subscriber's plan, depending on applicable law and the plan's terms and
conditions.
Covered services - ANSWER-Health care services that are included in and paid for by an
individual's health insurance or plan.
Excluded services - ANSWER-Health care services that an individual's health insurance or plan
doesn't pay for or cover.
Pre-existing condition - ANSWER-A medical condition that a person has before being enrolled
in a health plan.
Service area - ANSWER-The geographic area in which a health insurance plan's benefits are
made available. Some health insurance plans will not provide coverage outside of a plan's
service area.
Network - ANSWER-The facilities, providers and suppliers an individual's health insurer or plan
has contracted with to provide health care services.
Provider - ANSWER-A physician (M.D.- Medical Doctor or D.O.- Doctor of Osteopathic
Medicine), health care professional or health care facility licensed, certified or accredited as
required by state law.
Primary Care Provider/ Physician (PCP) - ANSWER-A physician (M.D. - Medical Doctor or D.O.-
Doctor of Osteopathic Medicine), 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.
Specialist - ANSWER-A physician specialist focuses on a specific area of medicine or a group of
patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A
non-physician specialist is a provider who has more training in a specific area of health care.
CCHI - Insurance.pdf CCHI - Insurance.pdf CCHI - Insurance.pdf
CCHI - Insurance
Affordable Care Act (ACA)/ Health Care Reform; Obamacare - ANSWER-The comprehensive
federal health care reform law enacted in March 2010.
Health Insurance - ANSWER-A contract that requires an individual's health insurer to pay some
or all of their health care costs in exchange for a premium.
Health Insurance Marketplace/ Exchange - ANSWER-State- or federally run and regulated
market where an individual can shop, compare, and buy health care coverage.
Eligibility requirements - ANSWER-Conditions that must be met in order for an individual or
group to be considered eligible for insurance coverage.
Open enrollment (period) - ANSWER-A period of time each year when an individual can
purchase or change health coverage.
Medicaid - ANSWER-Health insurance provided by the government to some low-income people,
families and children, pregnant women, the elderly, and people with disabilities. In some states
the program covers all adults below a certain income level. Medicaid programs must follow
federal guidelines, but coverage and costs may be different from state to state.
Children's Health Insurance Program (CHIP) - ANSWER-Health insurance provided by the
government to children in families that earn too much money to qualify for Medicaid. In some
states, CHIP covers parents and pregnant women. Each state works closely with its state
Medicaid program. In many cases, if an individual qualifies for Medicaid your children will qualify
for either Medicaid or CHIP.
Medicare - ANSWER-A federal health insurance program, administered by the Social Security
Administration, that provides health care for most people over 65 and certain other eligible
individuals.
Health plan - ANSWER-A benefit an individual's employer, union or other group sponsor
provides to that individual to pay for their health care services.
Secondary coverage - ANSWER-When a person is covered under more than one health
insurance plan, this term describes the health insurance plan that provides payment on claims
after the primary coverage (i.e. main plan).
Managed care - ANSWER-A general term used to describe a variety of health care and health
insurance systems that attempt to guide a patient's use of benefits, typically by requiring that a
CCHI - Insurance.pdf CCHI - Insurance.pdf CCHI - Insurance.pdf
, CCHI - Insurance.pdf CCHI - Insurance.pdf CCHI - Insurance.pdf
patient coordinate his or her health care through a primary care physician, or by encouraging
the use of a specific network of healthcare providers. The management of health care is
intended to keep costs -and monthly premiums- as low as possible. Examples of managed care
plans include:
• Health maintenance organizations (HMOs),
• Preferred provider organizations (PPOs),
• Exclusive provider organizations (EPOs), and
• Point of service plans (POSs).
Premium - ANSWER-The amount that must be paid for an individual's health insurance or plan.
The individual and/or their employer usually pay it monthly, quarterly or yearly.
Dependent - ANSWER-A spouse, child, or domestic partner who is covered under a
policyholder or subscriber's plan, depending on applicable law and the plan's terms and
conditions.
Covered services - ANSWER-Health care services that are included in and paid for by an
individual's health insurance or plan.
Excluded services - ANSWER-Health care services that an individual's health insurance or plan
doesn't pay for or cover.
Pre-existing condition - ANSWER-A medical condition that a person has before being enrolled
in a health plan.
Service area - ANSWER-The geographic area in which a health insurance plan's benefits are
made available. Some health insurance plans will not provide coverage outside of a plan's
service area.
Network - ANSWER-The facilities, providers and suppliers an individual's health insurer or plan
has contracted with to provide health care services.
Provider - ANSWER-A physician (M.D.- Medical Doctor or D.O.- Doctor of Osteopathic
Medicine), health care professional or health care facility licensed, certified or accredited as
required by state law.
Primary Care Provider/ Physician (PCP) - ANSWER-A physician (M.D. - Medical Doctor or D.O.-
Doctor of Osteopathic Medicine), 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.
Specialist - ANSWER-A physician specialist focuses on a specific area of medicine or a group of
patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A
non-physician specialist is a provider who has more training in a specific area of health care.
CCHI - Insurance.pdf CCHI - Insurance.pdf CCHI - Insurance.pdf
