Need help with the lingo? You don’t need to learn a whole new language, but here's a list of some terms you are likely to see as you review health insurance information. We've also created an online glossary called Just Plain Clear that has thousands of terms defined in plain, clear language.
Advanced Premium Tax Credit
A tax credit that can help you afford coverage bought through the Marketplace. Sometimes known as APTC, “advance payments of the premium tax credit,” or premium tax credit. Unlike tax credits you claim when you file your taxes, these tax credits can be used right away to lower your monthly premium payments.
Children's Health Insurance Program (CHIP)
Insurance program jointly funded by state and federal government that provides health coverage to low-income children and, in some states, pregnant women in families who earn too much income to qualify for Medicaid but can’t afford to purchase private health insurance coverage.
Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the allowed amount for an office visit is $100 and you've met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
The share of costs covered by your insurance that you pay out of your own pocket. This generally includes deductibles, co-insurance, and co-payments, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services.
The amount you owe for eligible health care services before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won't pay anything until you've met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
Emergency Room Care
Emergency services you get in an emergency room.
Health Insurance Marketplace (Exchange)
A resource where individuals, families, and small businesses can: learn about their health coverage options; compare health insurance plans based on costs, benefits, and other important features; choose a plan; and enroll in coverage. The Marketplace also provides information on programs that help people with low to moderate income and resources pay for coverage. In some states, the Marketplace is run by the state. In others it is run by the federal government.
Health Reimbursement Account (HRA)
Health care accounts that employers fund for covered workers or retired persons. The IRS does not tax this money and an employer may allow any money left in these accounts at the end of the year to roll over to be used the next year.
Health Savings Account (HSA)
A medical savings account available to taxpayers who are enrolled in a qualified High Deductible Health Plan. The funds contributed to the account aren't subject to federal income tax at the time of deposit (subject to limits). Funds must be used to pay for qualified medical expenses.
High-Deductible Health Plan
A plan that features higher deductibles than traditional insurance plans. High deductible health plans can be paired with a health savings account to allow you to pay for qualified out-of-pocket medical expenses on a pre-tax basis.
A state-administered health insurance program for low-income families and children, pregnant women, the elderly, people with disabilities, and in some states, other adults. The Federal government provides a portion of the funding for Medicaid and sets guidelines for the program. States also have choices in how they design their program, so Medicaid varies state by state and may have a different name in your state.
A Federal health insurance program for people who are age 65 or older and certain younger people with disabilities. It also covers people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
Open Enrollment Period
The period of time when you can re-enroll in the health plan you are already in or choose to enroll in another health plan.
The most you pay during a policy period (usually a calendar year) before your health insurance or plan starts to pay 100% for covered health benefits. This limit must include deductibles, co-insurance, co-payments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the health benefits.
The amount that must be paid for your health insurance or plan, usually monthly, quarterly or yearly.
Premium Tax Credit
The Affordable Care Act provides a tax credit to help qualifying individuals and families afford health coverage purchased through the Federally Facilitated Marketplace or state operated Exchange, depending on the state you reside in. If eligible, advance payments of the tax credit can be used right away to lower your monthly premium costs.
Prescription Drug Coverage
Health insurance or plan that helps pay for prescription drugs and medications.
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
Primary Care Physician (PCP)
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.
Qualifying Life Event
An event defined by the IRS that allows an individual to change their benefit selections. Examples of events may include marriage, divorce, adoption or birth of a child or death of a dependent.
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
Well-Baby and Well-Child Visits
Routine doctor visits for comprehensive preventive health services that occur when a baby is young and annual visits until a child reaches age 21. Services include physical exam and measurements, vision and hearing screening, and oral health risk assessments.
References to UnitedHealthcare pertain to each individual company or other UnitedHealthcare affiliated companies.
Insurance products and services offered are underwritten by All Savers Insurance Company, Health Plan of Nevada, Inc., UnitedHealthcare Community Plan, Inc., UnitedHealthcare Insurance Company, UnitedHealthcare of Alabama, Inc., UnitedHealthcare of Florida, Inc., UnitedHealthcare of Louisiana, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., UnitedHealthcare of the Midwest, UnitedHealthcare of Mississippi, Inc., UnitedHealthcare of New England, Inc., UnitedHealthcare of New York, Inc., UnitedHealthcare of North Carolina, Inc., UnitedHealthcare of Ohio, Inc., UnitedHealthcare of Pennsylvania, Inc., Oxford Health Plans (NJ), Inc.
Each company is a separate entity and is not responsible for another’s financial or contractual obligations.
Administrative services are provided by UnitedHealthcare Services, Inc. or by related companies.