CCHI - Insurance
The comprehensive federal health care reform law enacted in March 2010. - questions
and answersAffordable Care Act (ACA)/ Health Care Reform; Obamacare
A contract that requires an individual's health insurer to pay some or all of their health
care costs in exchange for a premium. - questions and answersHealth Insurance
State- or federally run and regulated market where an individual can shop, compare,
and buy health care coverage. - questions and answersHealth Insurance Marketplace/
Exchange
Conditions that must be met in order for an individual or group to be considered eligible
for insurance coverage. - questions and answersEligibility requirements
A period of time each year when an individual can purchase or change health coverage.
- questions and answersOpen enrollment (period)
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. -
questions and answersMedicaid
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. -
questions and answersChildren's Health Insurance Program (CHIP)
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. -
questions and answersMedicare
A benefit an individual's employer, union or other group sponsor provides to that
individual to pay for their health care services. - questions and answersHealth plan
, 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). - questions and answersSecondary coverage
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 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). - questions and answersManaged care
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. - questions and
answersPremium
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. - questions and
answersDependent
Health care services that are included in and paid for by an individual's health insurance
or plan. - questions and answersCovered services
Health care services that an individual's health insurance or plan doesn't pay for or
cover. - questions and answersExcluded services
A medical condition that a person has before being enrolled in a health plan. - questions
and answersPre-existing condition
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.
- questions and answersService area
The facilities, providers and suppliers an individual's health insurer or plan has
contracted with to provide health care services. - questions and answersNetwork
The comprehensive federal health care reform law enacted in March 2010. - questions
and answersAffordable Care Act (ACA)/ Health Care Reform; Obamacare
A contract that requires an individual's health insurer to pay some or all of their health
care costs in exchange for a premium. - questions and answersHealth Insurance
State- or federally run and regulated market where an individual can shop, compare,
and buy health care coverage. - questions and answersHealth Insurance Marketplace/
Exchange
Conditions that must be met in order for an individual or group to be considered eligible
for insurance coverage. - questions and answersEligibility requirements
A period of time each year when an individual can purchase or change health coverage.
- questions and answersOpen enrollment (period)
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. -
questions and answersMedicaid
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. -
questions and answersChildren's Health Insurance Program (CHIP)
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. -
questions and answersMedicare
A benefit an individual's employer, union or other group sponsor provides to that
individual to pay for their health care services. - questions and answersHealth plan
, 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). - questions and answersSecondary coverage
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 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). - questions and answersManaged care
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. - questions and
answersPremium
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. - questions and
answersDependent
Health care services that are included in and paid for by an individual's health insurance
or plan. - questions and answersCovered services
Health care services that an individual's health insurance or plan doesn't pay for or
cover. - questions and answersExcluded services
A medical condition that a person has before being enrolled in a health plan. - questions
and answersPre-existing condition
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.
- questions and answersService area
The facilities, providers and suppliers an individual's health insurer or plan has
contracted with to provide health care services. - questions and answersNetwork
