Word of the day

Monday, March 10

Premium Cap

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

Friday, March 7

Precertification

Preapproval from an insurance plan before an enrollee undergoes routine care.

Thursday, March 6

Employer-Sponsored Insurance (ESI)

Health coverage for employees and often for dependents that is provided by employers. A type of Group Health Insurance.

Wednesday, March 5

Tax Credit

An amount that a person or family subtracts from the amount of income tax that they owe.

Tuesday, March 4

Episode of Care

Refers to a period of illness, a hospital stay, or the duration of treatment for one condition.

Monday, March 3

Institute of Medicine (IOM)

A non-profit that works outside the government with a focus on providing unbiased advice for the public and private sector when making decisions regarding health.

Friday, February 28

ADT

Admissions, discharges and transfers (as in ADT orders)

Thursday, February 27

Employer Mandate

A provision in the Affordable Care Act that requires all employers to offer a defined standard of health benefits and pay a set portion of the cost of those benefits for their employees. Imposes a fee on employers with more than 50 employees who fall into certain categories. Fee structure: $2,000/full time employee (after the first 30) for companies that do not offer healthcare and have at least 1 full time employee receiving a premium tax credit; $2,000/full time employee (after the first 30) or $3,000/full time employee receiving a premium tax credit, whichever is less, for companies with more than 50 employees that offer health care. Also known as the Employer Shared Responsibility Requirement.

Wednesday, February 26

Grievance

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

Tuesday, February 25

Large Group Plans

Large group plans generally provide health coverage to over 100 members of the same group such as a company, association or union.