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

Individual Health Plan - Policies for people not connected to an employer group. Independent health plans for individuals.

Kassebaum-Kennedy Look at HIPAA.

Late Enrollment - Consists of enrollment in a healthcare plan during a time other than the regular or a special enrollment period. If it turns out that you are a late enrollee, you might be subjecedt to a longer pre-existing condition exclusion period.

Look Back - The maximum amount of time (immediately prior to signing up for a health plan) that can be examined for any type of evidence of preexisting conditions.

Maximum Out-of-Pocket - Maximum amount of money an insured will have to pay in a benefit period in addition to regular premium payments.

Nondiscrimination - A requirement that group health plans cannot discriminate against you simply based on your health status. Also, Your coverage within a group health plan cannot be denied or restricted, nor can you be charged a higher premium.

Pre-admission Certification - Determines whether a hospital should admit a patient and whether services can be provided on an outpatient basis; its goal is to eliminate unnecessary nonemergency procedures.

Pre-existing Condition Exclusion Period - Time during which a health plan won't pay for covered care related to a pre-existing condition.

Preferred Provider Organization (PPO) - Mode of health care delivery through which a sponsoring group negotiates price discounts with providers in exchange for more patients. The sponsor may be an insurer, employer, or third-party administrator.

Premium - Periodic payment made by a policyholder (employer, individual) for the cost of insurance.

Prudent Person Rule - Individual health plans only; a rule that allows insurers to exclude as pre-existing any condition for which most people would have sought care or treatment prior to enrolling in an individual health plan.

Reasonable and/or Customary Charges - Amounts charged by health care providers that are consistent with charges from similar providers for identical or similar services in a given locale.

Self-Insured Group Health Plans - Refers to plans that are set up by employers who set funds aside in order to pay their employees’ health claims. Employers must disclose in your benefits information whether an insurer is responsible for funding, or for only administering the plan. If the insurer is simply administering the plan, then it is self-insured. * * * Self-insured plans are regulated by the U.S. Department of labor.

State Continuation Coverage - This program, which is somewhat similar to COBRA, is available in some states, stating that if you are in a fully insured group health plan with fewer than 20 employees, then you also have rights to continue your health coverage when your job ends.

Supplemental Security Income (SSI) - A program that provides cash benefits to some very low income, disabled and elderly individuals. If you qualify for the SSI program, that means you generally qualify for Medicaid too. Medicaid coverage often continues for a limited time if your income increases so that you no longer qualify for SSI.

Temporary Assistance for Needy Families (TANF) - This is a program that seeks to provide cash benefits to lower income families who have children to take care of. If you are one who qualifies for TANF, then you generally also qualify for Medicaid.

Underwriting - Process by which an insurer determines whether or not and on what basis it will accept an application for insurance.

Waiting Period - The time you might be required to work for an employer before you can be eligible for any kind of health benefits.

Well-Child Care - Care given to children during the first six years of their lives. Services include age-appropriate (birth to age six) pediatric preventive services. Recommended services include a medical history and complete physical examination, as well as developmental assessment, immunizations, and laboratory services such as screening for lead exposure.

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