Word of the day

Wednesday, May 7

Redetermination

The process wherein individuals that are currently enrolled in an exchange plan (either state or federal) must re-establish their eligibility on an annual basis.

Tuesday, May 6

Board-certified

A title for physicians who have completed all preparatory work (medical school, residency, etc.) and have been approved to practice by a group of their peers.

Monday, May 5

Beneficiary

Any individual who is eligible to receive health coverage under an insurance plan. This includes any dependents or others who are covered by who are not primary policy holders.

Friday, May 2

Premium Cap

A limit on the maximum amount an insurer can charge for their coverage.

Thursday, May 1

Advance Directive

Patients and their doctors occasionally craft plans for future care in the event that the patient is unable to direct their care (in case of incapacitation or advanced illness).

Wednesday, April 30

Open Enrollment

Time period during which employees or individual market consumers can change their insurance plans or enroll in new ones.

Tuesday, April 29

Grievance

Complaints filed by individuals regarding coverage denial which they believe to be unreasonable.

Monday, April 28

Navigator

A third-party agent assigned to conduct public education about the availability of qualified health plans and help eligible consumers with the exchange enrollment process.

Friday, April 25

Benchmark Coverage

An alternative definition of basic care standards, found in the Social Security Act, that states may follow instead of Medicaid mandatory benefits requirements.

Thursday, April 24

Underinsured

Individuals who have health insurance but cannot access needed providers or cannot afford the cost sharing requirements.

Exchange-participating Health Benefits Plan Contract

Contracts between insurance providers and state health care exchanges allowing the provider to offer plans through the exchange.