HEALTH & FITNESS
21 things you MUST know about health insurance
Understandably, most people are uninterested in the subject of health insurance. It contains terms that you would never use in everyday conversation. Understandably, you’d prefer to avoid the whole thing. However, health insurance has an impact on your health, your family, and your finances. Understanding how it works and what you require can mean the difference between costly errors and peace of mind. Here are 21 terms to help you understand and make the most of your plan.
- Affordable Care Act
This is the healthcare reform legislation signed into law by President Obama in 2010. It is also well known as the Patient Protection and Affordable Care Act, or “Obamacare.” Some of the law’s provisions, such as universal coverage for preventive services, are already in effect. Others will be released in the coming years.
- Cancellations
Previously, some insurance companies would cancel health coverage if you made an error on your application. Companies are no longer permitted to do so under the ACA. However, they may cancel your coverage if you falsified or omitted information on your application or if you couldn’t pay your premium on time.
- COBRA
The Consolidated Omnibus Budget Reconciliation Act is abbreviated as COBRA. It is a federal law that gives you the right to continue with your employer’s group insurance plan for a limited time, after you leave a job, either voluntarily or unwillingly, or when you minimize your hours, such as from full-time to part-time.
- Copayments
A set amount of money (typically $15 or $20) that you must pay out of pocket for a healthcare service.
- Deductible
The amount of money you must pay for medical care out of pocket before your health insurance plan takes overpayments. Usually calculated annually, and the higher your deductible, the lower your monthly premium.
- Dependent coverage
Many insurance policies cover the policyholder’s family members as well. Dependent coverage for children must be available under the Affordable Care Act until an adult child reaches 26.
- Drug formulary
this is A list of every medication covered by your health insurance policy.
- Essential health benefits
some health plans for individuals and small groups are required by the Affordable Care Act to provide a comprehensive package of services and items. Pediatric care, hospitalization, maternity, and newborn care, and mental health treatments are essential health benefits. This Affordable Care Act provision went into effect in 2014.
- Grandfathered health plans
Purchased group or individual health plans on or before March 23, 2010. but most of the provisions of the Affordable Care Act do not apply to these plans.
- Health care plan categories
The insurance marketplace divides health care plans into four categories: bronze, silver, gold, and platinum. The plans differ based on how much you pay compared to how much the plan pays. Platinum plans provide the most coverage but charge the most money. Bronze plans have lower premiums but offer less coverage overall.
- HIPAA
this stands for Health Insurance Portability and Accountability Act. It is a federal law that governs, among other things, health information handling standards, your right to special enrollment in health plans when particular life or work events occur, confidentiality regarding protected health information, and the availability and renewability of health coverage.
- Individual mandate
The Affordable Care Act provision requires uninsured people to purchase health insurance or face a penalty.
- Lifetime limits
A limit on the total benefits you may receive from your insurance company throughout your life. The Affordable Care Act removes lifetime caps on essential health benefits. As of 2014, insurance companies are also prohibited from imposing yearly limits.
- Medicaid expansion
People with low incomes or with disabilities are eligible for government-funded health insurance. As a result of the Affordable Care Act, the program’s eligibility requirements have been expanded in some areas.
- MHPA
Mental Health Parity Act (MHPA) is a federal law that requires health plans to offer mental health benefits that are equivalent to the medical services provided by the plan. The MHPA only applies to employers with more than 50 employees.
- Minimum essential coverage
The smallest amount of health insurance that an individual must obtain to meet the individual responsibility needs of the Affordable Care Act and avoid a penalty.
- Preexisting condition
An illness or condition that existed before the start of a person’s group health plan coverage. As of 2014, insurance companies cannot refuse coverage or charge you more because you have a pre-existing medical condition.
- Premium
The sum of money that you or your employer must pay to keep your health insurance current. The sum is Typically paid monthly, quarterly, or annually.
- Preventive services
Your health insurance plan must fully cover preventive services under the Affordable Care Act. Mammogram screenings, colonoscopies, blood pressure screenings, and vaccines are examples of preventive services.
- Special enrollment
Participating in a group health plan when particular work or life events occur, regardless of the plan’s regular enrollment dates. When you, or your spouse or any other dependents lose other coverage;
when you marry or have a child, special enrollment is generally available. You must be given at least 30 days to request special registration under the plan.
- Summary of benefits and coverage
Your health insurance plan is required by the Affordable Care Act to provide you with an easy-to-understand summary of your coverage.
