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Stack #4390714
| Question | Answer |
|---|---|
| Affordable Care Act (ACA) | A federal statute signed into law on March 23, 2010, providing fundamental reforms to the U.S. healthcare and health insurance systems. |
| Agent | An individual or business entity licensed to sell, solicit, or negotiate insurance products within the state. |
| Aid Category | Refers to a particular group/category eligible for Medicaid. |
| Advanced Premium Tax Credit (APTC) | A type of Premium Tax Credit (PTC) that lowers premium costs for eligible individuals. |
| Appeal | A consumer’s right to request an evaluation and re-determination of health plan eligibility or features. |
| Application Organization (AO) | An organization helping consumers complete applications for health coverage through the federal Marketplace or Indiana Health Coverage Programs. |
| Authorized Representative | An individual or organization designated to act on behalf of a Medicaid or insurance affordability program applicant. |
| Auto Assignment | The process by which an individual is automatically assigned to a Managed Care Entity if they do not select one during the application process. |
| Behavioral and Primary Healthcare Coordination Program (BPHC) | A program that provides Medicaid Rehabilitation Option services to individuals with Serious Mental Illness. |
| Benefits Portal | A website developed by the Indiana Department of Family Resources for applying for Indiana Health Coverage Programs and checking application status. |
| Bronze Plan | A type of Qualified Health Plan where an insurance carrier pays 60% of covered healthcare expenses. |
| Care Management Organization (CMO) | An organization contracted to perform care management and utilization management for members in Care Select. |
| Catastrophic Plan | A health plan available for individuals under 30 or those with exemptions from the Individual Mandate. |
| Centers for Medicare & Medicaid Services (CMS) | A federal agency that administers Medicare and partners with states for Medicaid and CHIP. |
| Certificate of Coverage | A list of benefits, services, cost-sharing, exclusions, and limits of a health insurance policy. |
| Certified Application Counselor (CAC) | A federal consumer assistant certified to provide Marketplace education and enrollment assistance. |
| Child-only Policy | An Individual Market policy sold to a child under the age of nineteen. |
| Children’s Health Insurance Program (CHIP) | A health coverage program for children whose income is too high for Medicaid. |
| Coinsurance | A bill consumers might receive for a percentage of the cost of care after a visit. |
| COBRA Insurance | A type of temporary health insurance coverage that allows individuals to keep their insurance after certain qualifying events. |
| Conflict of Interest Policy | A document outlining potential conflicts of interest for Indiana Navigators and AOs. |
| Consumer Assistant | Individuals or entities providing outreach, education, or enrollment assistance with a Marketplace or Indiana Health Coverage Program. |
| Copayment (Copay) | A flat fee paid by consumers before seeing a healthcare provider. |
| Cost-sharing | A common feature of health insurance plans that varies between plans. |
| Cost-sharing reduction | A health-plan discount that lowers out-of-pocket costs for deductibles, coinsurance, and copayments. |
| Deductible | A set amount spent toward healthcare before insurance begins to pay. |
| Department of Health and Human Services (HHS) | The principal health agency of the U.S. federal government. |
| Dependent | A child up to 26 years old under the ACA who can stay on a parent's health insurance plan. |
| Division of Family Resources (DFR) | A division of the Indiana FSSA that establishes eligibility for Medicaid and other assistance programs. |
| Eligibility Group | Also referred to as Aid Category, it refers to a particular group eligible for Medicaid. |
| Eligibility Redetermination | The process of re-evaluating a consumer's eligibility for Medicaid or the federal Marketplace. |
| Enrollment Period | The time period in which individuals can apply for health coverage through the federal Marketplace. |
| Essential Health Benefit (EHB) | A type of benefit that insurance carriers are required to cover under the ACA. |
| Ethics | Standards that Indiana Navigators and Application Organizations must follow to improve consumer access to information. |
| Explanation of Benefits (EOB) | A document describing what an insurer paid for a health service and what the consumer owes. |
| Family and Social Services Administration (FSSA) | A healthcare and social service funding agency within the Indiana state government. |
| Family Planning Eligibility Program | An Indiana Medicaid program providing certain family planning services to eligible individuals. |
| Federal Marketplace | A federally-operated Marketplace that makes qualified health plans available to qualified individuals. |
| Federal Navigator | An entity trained and certified to provide Marketplace outreach and enrollment services. |
| Federal Poverty Level (FPL) | A figure released annually estimating the minimum income needed to cover basic living expenses. |
| Federally-facilitated Marketplace (FFM) | See Federal Marketplace. |
| Fee-for-Service | See Traditional Medicaid. |
| Flexible Spending Account (FSA) | A medical savings account allowing pre-tax contributions for future medical costs. |
| Gold Plan | A type of Qualified Health Plan where the insurance carrier pays 80% of healthcare expenses. |
| Health Insurance | Coverage that pays for healthcare costs, including losses from accidents and medical expenses. |
| Health Maintenance Organization (HMO) | A designation for health insurers that provide or arrange healthcare services on a prepaid basis. |
| Health Savings Account (HSA) | A medical savings account allowing pre-tax contributions for healthcare expenses. |
| Healthcare Provider | An individual or entity that provides healthcare services to patients. |
| Healthcare.gov | The federal Marketplace website for purchasing qualified health plans. |
| Healthy Indiana Plan (HIP) | Indiana's health coverage program for adults with low incomes. |
| Home and Community-Based Services (HCBS) Waiver | An Indiana Medicaid waiver designed to provide services to prevent institutionalization. |
| Hoosier Healthwise (HHW) | Indiana Medicaid’s program for low-income families, pregnant women, and children under 19. |
| In-Network Provider | A provider contracted with an insurer to provide services at a discounted rate. |
| Indiana Application for Health Coverage (IAHC) | An application for an Indiana Health Coverage Program. |
| Indiana Code 27-19 | An Indiana state statute establishing standards for Navigators and Application Organizations. |
| Indiana Department of Insurance (IDOI) | An agency that monitors and regulates the business of insurance in Indiana. |
| Indiana Health Coverage Program (IHCP) | Refers to various programs under Indiana Medicaid addressing medical needs of low-income populations. |
| Indiana Navigator | An individual who assists consumers in completing applications for health coverage. |
| Individual Market | The market for health insurance coverage offered to individuals outside of group plans. |
| Insurance Affordability Program | Refers to Premium Tax Credit (PTC) or Cost-sharing Reduction (CSR) programs established by the ACA. |
| Insurer | An insurance company with a certificate of authority to engage in the business of health insurance. |
| Managed Care Entity (MCE) | A term describing health plans designed to control healthcare delivery quality and cost. |
| Marketplace | A governmental agency making qualified health plans available to qualified individuals or employers. |
| Medicaid | A means-tested federal-state entitlement program providing low-cost health insurance to eligible individuals. |
| Medicaid Review Team (MRT) | A group that determines a Medicaid applicant’s eligibility based on a disability. |
| Medicare | A federal insurance program that guarantees access to health insurance for certain eligible individuals. |
| Medicare Savings Program | A Medicaid program helping beneficiaries pay for Medicare premiums and cost-sharing. |
| M.E.D. Works | Indiana’s health care program for working individuals with disabilities. |
| Metal Tier | Refers to the categories of health plans (Bronze, Silver, Gold, Platinum) based on cost-sharing. |
| Miller Trust | A legal arrangement allowing individuals with excess income to qualify for Medicaid coverage. |
| Minimum Essential Coverage (MEC) | Health insurance coverage required under the Individual Mandate of the ACA. |
| Modified Adjusted Gross Income (MAGI) | A methodology for determining eligibility for insurance affordability programs. |
| Non-Modified Adjusted Gross Income (Non-MAGI) Population | Population exempt from MAGI methodologies for Medicaid eligibility. |
| Office of Medicaid Policy and Planning (OMPP) | A department that administers Medicaid programs and reviews disability claims. |
| Open Enrollment Period | The timeframe in which individuals can apply for health coverage through the Marketplace. |
| Out-of-Network Provider | A healthcare provider not contracted with a particular insurer. |
| Out-of-pocket Maximum | The maximum amount a consumer pays for healthcare services before the insurer pays 100%. |
| Partnership Marketplace | A mix between the federal and state-based Marketplace allowing states to assume certain responsibilities. |
| Patient Protection and Affordable Care Act (PPACA) | See Affordable Care Act (ACA). |
| Pediatric | Refers to children under the age of nineteen whose healthcare services are considered Essential Health Benefits. |
| Personal Wellness and Responsibility Account | See POWER Account. |
| Platinum Plan | A type of Qualified Health Plan where the insurance carrier pays 90% of covered healthcare expenses. |
| Policy Year | The designated 12-month period for a health insurance policy. |
| POWER Account | An account used to pay medical costs for HIP recipients, valued at $1,100 per adult. |
| Pre-Authorization (PA) | The process of reviewing the medical necessity of a requested service. |
| Privacy and Security Agreement | An agreement defining consumer personal information privacy and security standards. |
| Provider | An individual or entity that provides healthcare or medical services to patients. |
| Qualified Health Plan (QHP) | A health insurance plan certified under the ACA to meet specific criteria for Marketplace availability. |
| Qualified Provider (QP) | An entity determined capable of making presumptive eligibility determinations. |
| Re-enrollment | The yearly process for consumers to re-enroll in coverage through a Qualified Health Plan. |
| Silver Plan | A type of Qualified Health Plan where the insurance carrier pays 70% of covered healthcare expenses. |
| Social Security Administration (SSA) | A federal agency determining Medicaid disability applications. |
| Social Security Disability Insurance (SSDI) | A federal insurance program providing benefits to qualified individuals who can no longer work. |
| Stand-Alone Dental Plan | Dental-only health insurance plans offered through the Marketplace. |
| Subsidy | See Premium Tax Credit (PTC). |
| Supplemental Nutrition Assistance Program (SNAP) | A federal aid program providing food assistance to low and no-income families. |
| Supplemental Security Income (SSI) | A federal program providing benefits to disabled individuals with limited income. |
| Special Enrollment Period | A timeframe outside of the open enrollment period for enrolling in health coverage due to qualifying life events. |
| State-based Marketplace | A Marketplace developed and operated by a state for making QHPs available. |
| Traditional Medicaid | A program providing healthcare coverage to low-income individuals without enrollment in a Managed Care Entity. |
| Transitional Medical Assistance (TMA) | A program providing continued Medicaid coverage to eligible individuals who lose Medicaid eligibility. |
| ACA | Affordable Care Act |
| AGI | Adjusted Gross Income |
| AO | Application Organization |
| APTC | Advanced Premium Tax Credit |
| BPHC | Behavioral and Primary Healthcare Coordination Program |
| CAC | Certified Application Counselor |
| CHIP | Children’s Health Insurance Program |
| CMO | Care Management Organization |
| CMS | Centers for Medicare and Medicaid |
| CSR | Cost-sharing Reduction |
| DFR | Division of Family Resources |
| EHB | Essential Health Benefits |
| EOB | Explanation of Benefits |
| FFE | Federally-Facilitated Exchange |
| FFM | Federally-Facilitated Marketplace |
| FFS | Fee for Service |
| FPL | Federal Poverty Level |
| FSSA | Family and Social Services Administration |
| HCBS | Home and Community-Based Services Waiver |
| HHS | Department of Health and Human Services |
| HHW | Hoosier Healthwise |
| HIP | Healthy Indiana Plan |
| HMO | Health Maintenance Organization |
| HSA | Health Savings Account |
| IAHC | Indiana Application for Health Coverage |
| IDOI | Indiana Department of Insurance |
| IHCP | Indiana Health Coverage Program |
| MAGI | Modified Adjusted Gross Income |
| MCE | Managed Care Entity |
| MCO | Managed Care Organization |
| MEC | Minimum Essential Coverage |
| MRT | Medicaid Review Team |
| OMPP | Office of Medicaid Policy and Planning |
| PA | Prior Authorization |
| PE | Presumptive Eligibility |
| PMP | Primary Medical Provider |
| POWER | Personal Wellness and Responsibility Account |
| PPACA | Patient Protection and Affordable Care Act |
| PPO | Preferred Provider Organization |
| PTC | Premium Tax Credit |
| QHP | Qualified Health Plan |
| QP | Qualified Provider |
| SNAP | Supplemental Nutrition Assistance Program |
| SSA | Social Security Administration |
| SSDI | Social Security Disability Income |
| SSI | Supplemental Security Income |
| TANF | Temporary Assistance for Needy Families |
| TMA | Transitional Medical Assistance |
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