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Access

The ability to attain medical care which can often be affected by the availability of insurance, price of care and the location of the needed care providers.

Accident Supplement Insurance

Additional insurance consumers can purchase if their current plan does not cover injuries resulting from accidents. Such supplements are general only needed for high-deductible, low-cost plans.

Accountable Care Organization (ACO)

A group of healthcare providers that come together to provide the full range of healthcare services for patients. The provider organization is responsible for the quality and price of the care and receives payment for all care that is provided to patients. Organizations are given financial incentives, such as allocated savings attained from these efforts, in order to promote the improvement the quality and price through the Medicare program.

Accreditation

A process through which providers (of health care, or health insurance) are certified to meet standards set forth by agencies that oversee them.

Actuarial Equivalent

A health benefit plan offering similar coverage to the standard benefit plan. The similar plan does not necessarily include the same premiums, cost sharing requirements or equal benefits. The costs to the insurers for each plan however, are the same.

Actuarial Value

The percentage of health care costs paid by the insurance plan for an average enrollee. The average number is calculated through the expected cost for the standard population under the health insurance plan. The standard assumptions and cost-sharing provisions are also taken into account when calculating the percentage. This value allows for health plans to be compared individually, however, the value does not contain premium costs paid by the enrollee. The value is only a representative of the population; it may not reflect the cost-sharing percentage for each individual.

Acute Episodes of Care

Timeframe encompassing the treatment period for a major health problem. These episodes are most commonly surrounding surgery and include pre- and post- surgical tests and post-operative care in addition to the surgery itself.

Adjudication

Administrative process for reviewing insurance claims

Administrative Costs

Administrative costs refer to outlays that are not directly related to the service or good a company is selling. For a standard business this could include computer systems, data entry personnel and the like. For a health insurance company, administrative costs refers to non-medical claim outlays. The other costs associated with providing benefits include claims processing, enrollment processing, legal services, accountants, advertising, overhead costs, etc… The Affordable Care Act sets limits on insurers’ administrative costs and profit.

Administrative Services Only (ASO)

A type of insurance plan where the employer pays the actual costs of insurance claims while the insurance company is only responsible for administering the plan – occurs when a company is “self-insured.”

Medicaid

A health insurance program managed by the state but jointly funded by the state and Federal government for children and adults with low incomes.