GLOSSARY - Know exactly what it is we're talking about

Balance Bill - Difference between the physician's actual fee and the amount covered by your plan.

Certificate of Creditable Coverage - This is a document provided by your health plan that lets you prove you were covered under that plan. These will usually be provided automatically whenever you choose to leave a health plan. You can obtain certificates at other times as well. Check out Creditable Coverage for further help.

COBRA - COBRA Stands for the Consolidated Omnibus Budget Reconciliation Act, a federal law that has been in effect since 1986. COBRA permits both you and your dependents to remain within your employer’s group health plan even after your job ends. If your employer has 20 + employees, then you might be eligible for COBRA continuation coverage when you retire/ quit/are fired.

Co-insurance - Money that the insured is required to pay for services, usually a certain percentage, after the deductible is met.

Continuous Coverage - Health insurance coverage uninterrupted by a break of 63 or more consecutive days.

Co-payment - See co-insurance.

Deductible - Amount of covered expenses that must be incurred and paid by the insured before benefits become payable by the insurer.

Family and Medical Leave Act (FMLA) - This is a Federal law that guarantees ~ 12 weeks of job protected leave for some employees whenever they are in need of taking time off due to serious illness, to have or adopt a child, or to provide care for another family member. After you qualify for leave under FMLA, you can continue coverage under your group health plan.

Federally Eligible - This referst to the status that you attain after you have had 18 months of continuous creditable health coverage. Under Federal law, if you are to be federally eligible then you must also have used up any COBRA or state continuation coverage; you can’t be eligible for Medicare/Medicaid; you can’t have any other health insurance; and you must apply for individual health insurance within a period of 63 days after losing your prior creditable coverage.

Fee-for-Service - Method of charging whereby a physician bills for each visit or service. Premium costs for fee-for-service agreements can increase if physicians or other providers increase their fees, increase the number of visits, or substitute more costly services for less expensive ones.

Formulary - List of certain drugs and their proper dosages. In some Medicare health plans, doctors must order or use only drugs listed on the health plan's formulary.

Fully Insured Group Health Plan - Health insurance that is purchased by an employer from an insurance company. The insurance is intended to cover a group of employees.

Genetic Information - Information regarding family history or genetic test results that might indicate your risk of developing any type of health condition.

Guaranteed Issue - Requirement that health plans must allow for you to enroll regardless of what your health status, age, gender, or other factors that might predict your use of health services might be.

Guaranteed Renewability - Feature in health plans in which your coverage cannot be canceled due to your get sick. HIPAA requires all health plans to be guaranteed renewable. Your coverage can be canceled for other reasons that are unrelated to the status of your health.

Health Insurance Portability and Accountability Act (HIPAA) - Also and more commonly known as the Kassebaum-Kennedy act. This is in reference to the two senators who were behind the bill. Passed in 1996 to help people purchase and hold onto health insurance, even if they have serious health conditions, the law sets a national floor for health insurance reforms.

Health Maintenance Organization (HMO) - An organization that provides for a wide range of comprehensive health care services for a specified group at a fixed periodic prepayment.

Health Plan Year - The period (calendar period) during which one’s health plan coverage is in effect. Most group health plan years start on January 1, whilst others start in another month.

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