Wednesday, February 4
Preventive Care
Care that focuses on early detection and prevention of diseases; the ACA mandates that certain preventive care services be covered with no cost-sharing.
Tuesday, February 3
Pay or Play
Colloquial term for an ACA provision requiring employers to offer health insurance or pay a fine.
Monday, February 2
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.
Thursday, January 29
Payment Bundling
A mechanism of provider payment where providers or hospitals receive a single payment for all of the care provided for an episode of illness, rather than per service. Total care provided for an episode of illness may include both acute and post-acute care.
Wednesday, January 28
Section 125 Plan
A plan that allows for employees to pay for health insurance premiums and receive certain benefits on a pre-tax basis.
Tuesday, January 27
Elimination Period
Time between when a policy holder is disabled and when insurance begins to pay out - also known as the Qualifying Period.
Monday, January 26
Qualified Health Plan (QHP)
Health insurance plans that are certified by HHS to be sold on the state or federal exchanges, these plans will meet all of the ACA insurance market requirements.
Friday, January 23
Premium Subsidies
A fixed percentage of the premium cost that helps individuals purchase health coverage on the new health insurance exchanges.
Thursday, January 22
Managed Care
A health delivery system that aims to limit health care costs and improve the quality of care by controlling access to the use of health care services.
Wednesday, January 21
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.