Word of the day

Monday, December 16

Agency for Healthcare Research and Quality (AHRQ)

A federal agency that compiles research on health care best practices and disseminates proven quality metrics.

Friday, December 13

Cadillac Tax

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.

Thursday, December 12

Uncompensated Care

The costs of health care services that are not paid for by the patient or by the insurer. Federal programs sometimes offer some help to providers to offset the cost of providing uncompensated care.

Tuesday, December 10

Member

A term for an individual with health coverage, also called policy holder, beneficiary or enrollee

Monday, December 9

Government Performance Results Act

A federal law that targets waste and fraud in federal programs.

Friday, December 6

National Association of Insurance Commissioners (NAIC)

Organization of state insurance regulators.

Thursday, December 5

Group Health Insurance

Health insurance purchased by a group of people (or on their behalf) rather than by an individual or family. Employer Sponsored Insurance is the most common form of group health insurance but associations and unions are other examples of entities that purchase and provide group health insurance.

Wednesday, December 4

Essential Health Benefits (EHB)

The Affordable Care Act requires that health plans on the individual and small group market, including all plans sold on the exchanges, contain a package of items and services. Required care services include: emergency services, ambulatory patient services, maternity care, pediatric care, mental health care, laboratory services, prescription drugs, and others.

Tuesday, December 3

Emergency Medical Treatment and Labor Act

Federal law requiring hospitals that participate in Medicare to screen and stabilize patients needing emergency care, regardless of their insurance status or ability to pay.

Monday, December 2

Adjudication

Administrative process for reviewing insurance claims

Point-of-service Plan (POS)

Insurance plans that allow enrollees to choose between in-network or out-of-network care providers, though the enrollee will generally pay less for in-network care.