The patient protection and affordable care act sweeping health care reform legislation signed into law by president obama in march 2010. Members should look to their health plan documents only for the definitions that govern their health plan benefits. The most important terms in health care policy, from a to z. Make affordable health insurance available to more people. The health care world is full of terms and acronyms that can often be confusing and hard to understand. In compliance with the affordable care act aca, every issuer must supply this document and a uniform glossary of common health terms to members and prospective members during open enrollment or upon request. Summary of benefits and coverage and uniform glossary u. It provides simple and straightforward definitions of key terms that are part. Summary of benefits and coverage sbc template ms word format. A process of direct standardization designed to account for age as a confounding variable.
Heres a glossary of common terms to help you better understand the words and phrases currently associated with health care reform. Here are some frequently used terms and their definitions. The comprehensive health care reform law enacted in march 2010 sometimes known as aca, ppaca, or obamacare. Glossary of healthcare terms health insurance and reform.
It provides simple and straightforward definitions of key terms that are part of the health reform law. Medicaid is a federal entitlement program that provides health and long term care coverage to certain categories of lowincome americans. Health care reform glossary terms you should know florida. Each term on this page includes a brief definition. The health reform law placed certain coverage requirements on essential health benefits, and provides a broad set of benefit categories that would be considered essential to a health benefits package including hospitalization, outpatient services, emergency care, prescription drugs, maternity care, preventive services and other benefits. Accountable care organization aco a network of health care providers that band together to provide the full continuum of health care services for patients. Glossary of health coverage and medical terms page 2 of 6 deductible an amount you could owe during a coverage period usually one year for covered health care services before your plan begins to pay. Instructions for completing the sbc group health plan coverage and consumer assistance programs. As the battle over the best model rages on, we are left with a dizzying array of terms, abbreviations and concepts. The organizations payment is tied to achieving health care quality goals and outcomes that result in cost. In compliance with the affordable care act aca, every issuer must supply this document and a uniform glossary of common health terms to members and prospective members during open enrollment or upon request the sbc provides a brief summary of information that includes. Glossary of health reform ifc benefit solutions, inc.
The main sources for this glossary are the alliance for health reform and the kaiser family foundation. Some terms may have multiple and varying definitions based on the context and primary source of authority. Military health system mhs health care glossary serves as the official repository and consolidated reference as a secondary source for terms and definitions used within the mhs. Annual deductible the amount of eligible expenses you are required to pay annually before reimbursement by your health plan begins. If you need help with health insurance jargon and terminology, please see the information below for definitions of important health insurance terms, abbreviations, and acronyms. Below are definitions for some of the more commonly used terms and how. Health care reform can seem confusing, in part because of the technical vocab used to discuss the topic. This information is for illustrative purposes only and is being provided to help increase understanding of the impacts of some of.
A complaint that you communicate to your health insurer or plan. The percent for example, 20% you pay of the allowed amount for covered health care services to providers who contract with your health insurance or plan. An overall deductible applies to all or almost all covered items and services. Called the affordable care act aca, this law to reform the nations health care system was signed by president barack obama in march 2010 to help more people get affordable, quality health care. An accountable care organization is a group of providers who have organized themselves in a way that enables them to take accountability for the overall quality of care and the total cost to payers of all or most of the healthcare services needed by a group of patients. The purpose of the law was to expand access to highquality affordable health insurance. The purpose of the law is to expand access to highquality affordable health insurance. In this glossary, you will find some of the most common terms, with explanations that can turn you into a health care expert.
Coordinated care helps ensure that patients get the right care at the right time with the goal of avoiding unnecessary duplication of services and preventing medical errors. A group or network of doctors, hospitals, and clinics where you receive health care if youre in an hmo. Glossary of health coverage and medical terms omb control numbers 15452229, 12100147, and 09381146 page 1 of 6 glossary of health coverage and medical terms this glossary defines many commonly used terms, but isnt a full list. The name affordable care act is used to refer to the final. A fixed amount of funding that the federal government provides to states for broadly defined functions, such as community development or social services. The following is a glossary of terms commonly used in the discussion on reform of payment and delivery models in health care. Medical is a california health coverage program for lowincome families. The senate help health, education, labor, and pensions committee is one of two committees in the senate, along with three in the house, drafting health care reform legislation this summer.
Glossary of health care business terms accountable care organizations acos accountable care organizations acos are designed to be patientcentered and to network physicians, hospitals, and other health care professionals, such as audiologists and speechlanguage pathologists, with the patients and each other for partnering in care decisions. Glossary of key terms in health care reform ibxtpa. Also called health insurance marketplaces, these sites will be operated by the federal or. Our tax experts have put together a handy glossary of the most common terms surrounding the affordable care act. Durable medical equipment dme early and periodic screening, diagnostic, and treatment services epsdt eligibility assessment. Health care services that help a person keep, learn or. Health care services that your health insurance or plan doesnt pay for or cover. Webmd provides definitions of terms related to health insurance, the affordable care act and medicare. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance. A plainlanguage summary of your benefits and coverage. The new healthcare reform law, also known as the affordable care act, brings with it some terms that may be unfamiliar.
Patient protection and affordable care act aca also known as obamacare, this law reformed much of the health care system and created several programs on which macra builds. Computerized provider order entry cpoe a computer application that allows a physicians orders for diagnostic and treatment services such as medications, laboratory, and other tests to be entered electronically instead of being recorded on order sheets or prescription pads. Although the outcome of debates over specific reforms is not known, audiologists, like other health care professionals, need to be familiar with such terms. The ability to get needed medical care and services. Aug 15, 2016 the health care world is full of terms and acronyms that can often be confusing and hard to understand. A new health reform law passed in 2010 aimed at changing americas health care system to improve access and affordability for more americans. A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of patient care. Coinsurance a percentage of a health care providers charge for which the patient is financially responsible under the terms of the policy. This information is for illustrative purposes only and is being provided to help increase understanding of the impacts of some of the provisions of the affordable care act aca.
Summary of benefits and coverage sbc templates, instructions, and related materials for plan years beginning on or after 4117. The patient protection and affordable care act commonly called the affordable care act, aca, or health care reform is an important national issue. Glossary of health care reform terms blue hills sports. Health it terms glossary of selected terms related to health it computerized provider order entry cpoe a computer application that allows a physicians orders for diagnostic and treatment services such as medications, laboratory, and other tests to be entered electronically instead of being recorded on order sheets or prescription pads. In the meantime, well continue to add to the health care reform glossary. The law provides consumers with subsidies premium tax credits that lower costs for households with incomes between 100% and 400% of. We want to help you to understand health insurance so you can make the most of your health plan.
Health care coverage that is offered to individuals and not through a group health plan. Glossary includes many commonly used health coverage and medical terms, but. Health care reform glossary north dakota insurance. In healthcare, bundled payments are a reform of the traditional feeforservice reimbursement model. Health care reform glossary blue cross and blue shield. Health care reform is complex and some of the terms may be unfamiliar. Sign in cdphp home health insurance for individuals.
Health care reform glossary hawaii medical service. In california, this included the creation of a new health insurance marketplace called covered california and the expansion of. When a thirdparty payer, such as an insurance company or. The health care reform law enacted in march 2010 in two parts. When an aco succeeds in both delivering highquality care and spending health care dollars more wisely, it will share in the savings it achieves for the payer. The main sources for this glossary are the alliance for health reform and the kaiser family. With new terms being created through the aca, it can be difficult to keep track of everything. Major provisions are scheduled to gradually go into effect between now and 2014.
Health care reform glossary north dakota insurance department. The levels refer to the amount of money you and your insurance company will pay towards your health care. Also known as the patient protection and affordable care act ppaca, health care reform hcr and obamacare, it is the. Sep 12, 20 the new healthcare reform law, also known as the affordable care act, brings with it some terms that may be unfamiliar. Health care reform glossary of terms depaul university.
This glossary is intended to serve as a resource for understanding the concepts included in the affordable care act. Find the definitions you need to help better understand your health care. The payment reform glossary a accountable care organization aco. The patient protection and affordable care act aca is a federal law passed in 2010 aimed at reforming the health care system. Grandfathered status health insurance plans in effect as of march 23, 2010, are grandfathered under the health care reform law and will be considered qualified coverage that meets the mandate to have health insurance that begins january 2014. Health care reform glossary blue cross and blue shield of. This program is funded by state and federal dollars. When making decisions about health coverage, consumers should know the specific meanings of terms used to discuss health insurance. The controversial law is designed to lower health care and insurance costs and improve accessibility to health care. The patient protection and affordable care act ppacaaffordable care act acaobamacare the comprehensive federal health care reform law public law 111148 signed by president obama on march 23, 2010. Flexible spending account fsa health insurance marketplace.
Glossary of healthcare terms health insurance and reform accountable care organization aco. Health insurance portability and accountability act of 1996 hipaa health maintenance organization hmo health reimbursement arrangement hra health savings account hsa highdeductible health plan hdhp indemnity health plan. On march 23, 2010, president obama signed the patient protection and affordable care act ppaca into law. Department of health and human services hhs dependent coverage. H health insurance exchange the new websites where millions of people will shop for, compare and buy health insurance beginning on october 1, 20. For more information, click on a term to be directed to a more indepth page on the subject. Dhs health care reform training 1 revised 12314 health care reform training glossary. Copayment a flatdollar amount which a patient must pay when visiting a health care provider. Coinsurance a percentage of a health care providers charge for which the patient is financially responsible under the terms of the policy copayment a flatdollar amount which a patient must pay when visiting a health care provider deductible a dollar amount that a patient must pay for.
This glossary defers to other resources to define common health care terms, such as provider, deductible, and dependent, but offers definitions such as managed care and electronic health record to share how the terms are used under healthier washington. Glossary of terms help center vermont health connect. Coinsurance a percentage of a health care providers charge for which the patient is financially responsible under the terms of the policy community rating a way of pricing insurance where every policyholder pays the same premium, regardless of health status, age or other factors. On march 23, 2010, president obama signed this comprehensive health reform, into law. Health it terms glossary of selected terms related to health it.
Some of the terms shown here will likely generate debate. Advanced premium tax credit aptc an advance payment of the premium tax credit from the internal revenue service that is applied towards the cost of purchasing a qualified health plan. Glossary of commonly used healthcare acronyms and terms. Healthcare reform glossary of terms term spelled out what it means aca affordable care act ppaca, signed into law on march 23, 2010,was amended by the health care and education reconciliation act on march 30, 2010. The following is a glossary of the terms used in the healthcare policy project. These definitions are not meant in every case to conform to the definitions in a members health plan contract or evidence of coverage. Compliments of blue cross and blue shield of illinois, a division of health care service corporation, a mutual legal reserve company, an independent licensee of the blue cross and blue shield association 25338. Glossary key terms in health care reform bluecross. The quality of the coverage and benefits is the same for all plans. All rights reserved capital district physicians health plan, inc. Health care reform glossary there has been a lot of debate regarding the need for a change in our healthcare systemchanges in delivery, changes in charges and changes in enrollment. The patient protection and affordable care act aca is a federal law passed in 2010 that aimed to reform the u.
The way the federal health care reform law describes the different types of plans you can get through vermont health connect. Advancing care information aci aci is the new term for meaningful use under mips. The following is a glossary of health insurance terms that may help answer your questions. Abortion services accountable care organization accreditation actuarial value adjusted gross income agi advance premium tax credit. Managed care is a health care system in which the health care provider, in return for a fixed fee per year from a health plan, manages the care of the individual, including decisions about whether a specialist is required. Affordable care act explained glossary of terms kaiser. Accountable care organization aco acos are groups of doctors, hospitals, and other health care professionals who. This committee has broad jurisdiction over the operation of our nations health care, schools, employment, and retirement programs. Leave us a comment below with any terms youd like us to include.
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