Cadillac Health Plan
A colloquial term for expensive health plans – with generous benefits. The Affordable Care Act puts a tax on employer-sponsored plans with total premiums over an adjusted price starting in 2018.
The High Cost Plan Excise Tax, which is often referred to as the “Cadillac Tax” is one of the revenue raising provisions in the 2010 Patient Protection and Affordable Care Act. The excise tax is calculated by comparing the cost of an employer-sponsored plan (which includes premiums paid by the employer and/or employee as well as any contributions into health accounts such as health savings accounts of flex savings accounts) to a benchmark, which will be adjusted every year based on the Consumer Product Index (CPI). Any amount above the benchmark is taxed at 40 percent; this tax is levied on the health insurance company but is generally understood to be passed onto the consumer, or firm purchasing that plan.
A supplement to traditional coverage allowing employees to set up Flexible Spending Accounts. These accounts allow employees to set aside up to $2,500 in wages annually, tax free. Funds in Flexible Spending Account can be used to cover expenses not covered by the employee's health insurance, such as over the counter medication, dental work, co-pays, or deductibles.
Cancellation of Coverage
A process through which insurance providers can cancel health coverage after having granting it – this can only be done in cases of fraud.
A payment based on the individual (for a set period of time) rather than a per-service payment. Insurance plans tend to pay a physician network a certain per member per month payment to cover all of the services needed by that individual.
Courses of treatment that have been approved by national oversight organizations.
Broad term for health care companies that includes both insurance providers and health maintenance organizations (HMOs)
Treatments or services that are received outside of scope of an insurance policy; these are usually reimbursed at a different rate.
Organizing medical care across providers for individuals who have high healthcare needs. Case managers coordinate this process.
Case Mix Index (CMI)
A value that is assigned to a diagnosis-related group of patients. It is used in order to determine the distribution of resources for the care and treatment of patients in the group.