Words, Terms, and Acronyms

The Patient Protection and Affordable Care Act (PPACA or ACA) has been in the news in some form or another just about every day for the past year. As we are heading into the final stretch before the launch of the new health insurance requirements, print news, television news bites, internet news articles, Facebook, etc. are bombarding us by the hour with updates. And by now you probably have somewhat of a foggy, grey, not-quite-clear idea of what’s going on….or like many Americans out there…you still don’t have a clue.

Let’s do a little bit of a review of some of the more important terms associated with the ACA. Note, in noooo way is this list all-encompassing…

Terms and Acronyms

Actuarial value (AV)
Percentage of what your health plan will pay of your expenses.

Health care items and services covered under your insurance plan.

Your share of the costs of a covered health care service, calculated as a percent of the allowed amount for the service.

A fixed amount you pay for a covered health care service (i.e. Doctor visit). Amount may vary depending on the service.

The amount you owe for health care services before your health insurance plan begins to pay.

Essential Health Benefits (EHB)
A minimum set of health care service categories that must be covered by ALL plans beginning in 2014.

Health Insurance Exchange or Marketplace: a new competitive insurance marketplace where consumers can compare and purchase affordable and qualified health insurance beginning in plan year 2014.

Federally Facilitated Exchange (FFE)
HHS will establish and operate an Exchange in every state and the District of Columbia that does not opt to establish one for themselves.

Federal Poverty Level (FPL)
A measure of income level issued annually by the Department of Health and Human Services.

Flexible Spending Arrangement (FSA)
A way to pay for your out-of-pocket health-related expenses with tax-free dollars through your paycheck.

U.S. Department of Health and Human Services (HHS)
Federal agency responsible for implementing the requirements of the ACA.

Health Savings Account (HSA)
A medical savings account (pre-tax or tax deductible) available to those who are enrolled in a High Deductible Health Plan.

Metallic Plans
Four insurance plan levels (Bronze, Silver, Gold, Platinum) that were developed by ACA requirements. The plans are based on actuarial values.

Persons or organizations providing assistance and guidance to consumers about the Exchange.

Open Enrollment Period
The period of time set up to allow you to choose from available plans, usually once a year. Under the new ACA, open enrollment for consumers through the Exchange will begin October 1, 2013 for plan year beginning January 1, 2014.

Out-of-Pocket Limit
The most you pay during an annual policy period before your insurance plan pays 100% of the allowed amount.

Preferred Provider Organization (PPO)
A health plan that contracts with a network of medical providers (doctors, hospitals, pharmacies, etc.) who are considered “in-network”.

Pre-existing Condition
A condition, injury, or illness (physical/mental) that you have before you’re enrolled in a health plan.

The amount of money that must be paid for your health insurance or plan on a monthly basis.

Qualified Health Plan (QHP)
Beginning in 2014, under the ACA, an insurance plan that is certified by an Exchange that provides essential health benefits.

State Based Exchange (SBE)
A new health insurance exchange/marketplace that will be operated by an individual state.

Small Business Health Options Program (SHOP) 
program designed to simplify the process of finding and providing health insurance for small businesses employees.

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