This List of Terms is provided as a reference to define commonly unknown, or misunderstood, terminology within the health care benefits industry. It is not intended to be an exhaustive list of health care benefits-related terms. These definitions are provided by the Health Insurance Marketplace, a federal government website managed by the U.S. Centers for Medicare & Medicaid Services; the Washington Healthplanfinder Glossary of Terms and supplemented by the Fred Hutch/SCCA Human Resources Department.
Affordable Care Act
The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name "Affordable Care Act" is used to refer to the final, amended version of the law. (Informally referred to as "ACA" and "Obamacare.")
Co-insurance
The percentage you pay when your health plan pays less than 100 percent for covered services. Your health plan will not pay toward services with a coinsurance until you have paid your annual deductible. You will be responsible for paying a percentage of the cost of services that have a coinsurance. Your health plan will pay the remaining amount. (This applies to Fred Hutch Premera plans) An example of how co-insurance works: an in-network x-ray costs $300 and the in-network co-insurance for this service is 10%. You have already paid your annual deductible. You will pay $30 and the plan will pay $270.
Copayment
A fixed amount (for example, $25) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.
Deductible
The amount you owe for covered health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you've met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
Domestic Partnership
Two people of the same or opposite sex who live together and share a domestic life, but aren't married or joined by a civil union. In some states, domestic partners are guaranteed some legal rights, like hospital visitation. (Informally referred to as "DP.")
Open Enrollment Period
The period of time during which eligible employees can enroll in, or make changes to, their health and dental plan benefit elections. Fred Hutchinson Cancer Center's open enrollment period runs in May. After open enrollment ends, benefits changes can only be made if you have a qualifying event as defined by the IRS. (Informally referred to as "OE.")
Out of Pocket Maximum
The most you pay during a plan year before your health insurance plan begins to pay 100 percent of the allowed amount. When you reach the out-of-pocket maximum, you are not responsible for any further coinsurance costs for covered services during that calendar year. You may still be required to pay applicable co-pays. This limit never includes your premium, balance-billed charges or health care services your health insurance plan doesn't cover. There is a separate annual out of pocket maximum for any out-of-network services and any amount you pay toward this out-of-pocket maximum is separate from your in-network out-of-pocket maximum.
Plan Year
A 12-month period of benefits coverage under a group health plan. This 12-month period may not be the same as the calendar year. Fred Hutch's plan year is July 1 to June 30.
Premium
The amount that must be paid for your health insurance or plan. Your and/or your employer usually pay it monthly, quarterly or yearly.
Qualifying Event
A change in your life that can make you eligible for a special enrollment period to enroll in or change your benefit elections. Some examples of qualifying events are: marriage, divorce, childbirth or child adoption, loss or gain of coverage due to termination/commencement of employment. Election changes as a result of a qualifying event must be made within 30 days of the event.
Washington Apple Health
Washington state health care programs such as Medicaid and the Children's Health Insurance Program, or CHIP.