ACA - Affordable Care Act: The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”) requires that all health insurance plans in Oregon must be ACA compliant. All Oregon health insurance plans are Obamacare plans. No Oregon insurance companies are allowed to offer non-ACA compliant plans. Which means all coverage, deductibles, out of pocket maximums are dictated by the Affordable Care Act.
1099: 1099 contractor who is not paid as aw2 employee.
Obama Care: The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”) requires that all health insurance plans in Oregon must be ACA compliant. All Oregon health insurance plans are Obamacare plans. No Oregon insurance companies are allowed to offer non-ACA compliant plans. Which means all coverage, deductibles, out of pocket maximums are dictated by the Affordable Care Act.
Subsidy: a government premium credit to help reduce an individual’s monthly premium
Group Health Insurance: company health insurance with one or more w2 employees.
Individual/Family: an individual plan for covering one or more person in a family for health insurance directly with an insurance company.
COBRA: The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102% of the cost to the plan.
Alternative Care: naturopathic, acupuncture, chiropractic and other non traditional medicine.
Short Term Insurance: health insurance for 90 days or less designed to bridge the gap between long term insurance plans.
HSA: Health Savings Account: A Health Savings Account (HSA) is a tax-advantaged account created for or by individuals covered under high-deductible health plans (HDHPs) to save for qualified medical expenses. Contributions are made into the account by the individual and are limited to a maximum amount each year.1 The contributions are invested over time and can be used to pay for qualified medical expenses, such as medical, dental, and vision care, as well as prescription drugs.
Accident Insurance: insurance that only covers injuries due to accidents.
State Continuation: is available to employees who work for a company under 20 employees that provides health insurance. It allows employees to continue their group plan for up to 9 months after their employment ends.
OHP: Oregon Health Plan: state of Oregon Medicare plan you must qualify for due to low income.
HMO - An HMO, or Health Maintenance Organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from. It usually has lower monthly premiums than a PPO or an EPO health plan. An HMO may be right for you if you’re comfortable choosing a primary care provider (PCP) to coordinate your health care and are willing to pay a higher deductible to get a lower monthly health insurance premium.
PPO - Preferred Provider Organization: A PPO, or Preferred Provider Organization, is a type of health plan that offers a larger network so you have more doctors and hospitals to choose from. Your out-of-pocket costs are usually higher with a PPO than with an HMO or EPO plan. If you're willing to pay a higher monthly premium to get more choice and flexibility in choosing your physician and health care options, you may want to choose a PPO health plan.
EPO - Exclusive Provider Organization: An EPO, or Exclusive Provider Organization, is a type of health plan that offers a local network of doctors and hospitals for you to choose from. An EPO is usually more pocket-friendly than a PPO plan. However, if you choose to get care outside of your plan’s network, it usually will not be covered (except in an emergency). If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need health care, you may want to consider an EPO plan.
Health Care Reform: The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”) requires that all health insurance plans in Oregon must be ACA compliant. All Oregon health insurance plans are Obamacare plans. No Oregon insurance companies are allowed to offer non-ACA compliant plans. Which means all coverage, deductibles, out of pocket maximums are dictated by the Affordable Care Act.
Guaranteed Issue: coverage for an insurance plan cannot be denied due to a pre-existing medical condition.
Open Enrollment: enrollment period for health insurance plans where individuals and employees are free to enroll and make changes to their health plan. For individual plans open enrollment runs from November 1st to December 15th. This open enrollment period is mandated by the federal government.
Marketplace: federal website to apply for individual health insurance.
Special enrollment periods: You may qualify for a special enrollment period throughout the year. These are called qualifying life events and are time sensitive. You must apply within 60 days of the common qualifying event. Some common qualifying life events are: loss of group health insurance plan, Medicaid, CHIP, moved out of current plans coverage area, marriage, divorce, loss.
*qualifying life events: They are time sensitive. You must apply within 60 days of the common qualifying event. Some common qualifying life events are: loss of group health insurance plan, Medicaid, CHIP, moved out of current plans coverage area, marriage, divorce, loss.
You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days: Loss of qualified health coverage, change in residence, got married, had a baby, got divorced, or someone on your current plan died.
Self Employed: someone working for themselves or as a 1099 contractor.
Doctor Copay: the out of pocket cost to see a doctor. On most plans the deductible is waived for doctor visits copays.
PCP - Primary Care Physician: your primary general practitioner who many times is required to refer you to a specialist.
Deductible: Typically the amount to be paid by the insured before coverage starts for major services.
Maximum out of Pocket: the amount that must be paid by policy holder before insurance company pays 100%.
CHIP - Children's Health Insurance Plan: Oregon Medicaid plan for children.
ACA required preventative/essential health insurance services must cover specific "essential health benefits" including:
* Ambulatory patient services
* Breastfeeding
* Emergency services
* Family planning
* Hospitalization
* Laboratory services
* Mental health and substance use disorder services
* Pregnancy, maternity, and newborn care
* Prescription medications
* Preventive and wellness services and chronic disease management
* Pediatric services
* Rehabilitative and habilitative service
