The health insurance industry tends to cause a lot of confusion for individuals shopping for a health plan. The primary reason for this confusion is the excessive use of acronyms! Below is a comprehensive list of healthcare acronyms:
A
ACA: (Patient Protection and) Affordable Care Act
ACO: Accountable Care Organization
AD&D: Accidental Death and Dismemberment
ADA: American with Disabilities Act of 1990
AGI: Adjusted Gross Income
ALOS: Average Length of Stay
AMA: American Medical Association
APTC: Advanced Premium Tax Credit
ASC : Ambulatory Surgery Center
B
BOI: Bureau of Insurance
C
CDHP: Consumer-Directed Health Plan
CHAMPUS: Civilian Hospital and Medical Program of the Uniformed Service. Now known as Tricare.
CHIP: Children’s Health Insurance Program
CIN: Clinically Integrated Network
CMS: Centers for Medicare and Medicaid Services (previously HCFA)
COB: Coordination of Benefits
COBRA: Consolidated Omnibus Reconciliation Act (extension of coverage)
COI: Certificate of Insurance
Co-Op: Cooperative Insurance
CPT: Current Procedural Terminology (Level 1 codes)
CSR: Cost Sharing Reduction
D
DMAS: Department of Medical Assistance Services
DHHS / HHS: Department of Health and Human Services
DME: Durable Medical Equipment
DOL: Department of Labor
DOS: Date of Service
E
E & L: Exclusions and Limitations
EAP: Employee Assistance Program
ECM: Exemption Certificate Number
EMT: Emergency Medical Technician
ENT: Ears, Nose and Throat
EOB: Explanation of Benefits
EOC: Evidence of Coverage (HMO / POS Plan Documentation)
EPO: Exclusive Provider Organization
EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
ER: Emergency Room
ERISA: Employee Retirement Income Security Act
ESRP: Employer Shared Responsibility Payment
F
FAMIS: Family Access to Medical Insurance Security Plan
FDA: Food and Drug Administration
FEHBP: Federal Employee Health Benefit Plan
FFS: Fee for Service
FMLA: Family and Medical Leave Act
FPL: Federal Poverty Level
FQHC: Federally Qualified Health Center
FSA: Flexible Spending Account
FTE: Full-Time Employee
G
GEHA: Government Employees Health Association
H
HCBS: Home and Community-Based Services
HDHP: High-Deductible Health Plan
HEDIS®: Health Plan Employer Data and Information Set
HIPAA: Health Insurance Portability and Accountability Act
HMO: Health Maintenance Organization
HRA: Health Reimbursement Account
HSA: Health Savings Account
I
ICU: Intensive Care Unit
IRF: Inpatient Reading Fee
ISO: International Student Organization
J
JCAHO: Joint Commission on the Accreditation of Hospital Organizations
L
LOS: Length of Stay
LPN: Licensed Practical Nurse
LTD: Long Term Disability
M
MAGI: Modified Adjusted Gross Income
Max: Maximum
MD: Medical Doctor
MEC: Minimum Essential Coverage
MLR: Medical Loss Ratio
MOOP: Maximum Out of Pocket
MRI: Magnetic Resonance Imaging
N
NAIC: National Association of Insurance Commissioners
NCQA: National Committee for Quality Assurance
NIMH: National Institute of Mental Health
Non-par: Not participating (out-of-network)
NPI: National Provider Identifier
O
OOIDA: Owner-Operator Independent Drivers Association
OOP: Out of Pocket
OPM: Office of Personnel Management
OPT: Optional Practical Training
OSHA: Occupational Safety and Health Act
OTC: Over the Counter
OV : Office Visit
P
P&T: Pharmacy & Therapeutics Committee
Par: Participating (in-network)
PCMH: Patient Centered Medical Home
PCIP: Pre-existing Condition Insurance Plan
PCP: Primary Care Physician
PERS: Public Employees Retirement System
PHA: Personal Health Assessment
PHI: Protected Health Information
PHIP: PERS Health Insurance Program
POA: Power of Attorney
POS: Point of Service
PPACA: Patient Protection and Affordable Care Act
PPO: Preferred Provider Organization
Pre-auth: Pre-Authorization
Pre-X: Pre-existing Conditions
PT: Physical Therapy
Q
QHP: Qualified Health Plan
QLE: Qualifying Life Events
R
ROI: Release of Information
RX: Prescription
S
SBC: Uniform Summary of Benefits and Coverage
SEP: Special Enrollment Period
SF: Self-Funded
SHIP: State Health Insurance Assistance Program
SNF: Skilled Nursing Facility
SLCSP: Second Lowest Cost Silver Plan
SSI: Supplemental Security Income
STD: Short-Term Disability
T
TEFRA: Tax Equity and Fiscal Responsibility Act of 1982
TPA: Third-Party Administrator
TRICARE: Managed Healthcare System for military families
TTY: Teletypewriter
U
UCC: Urgent Care Center
UCR: Usual, Customary, and Reasonable
V
VA Hospital: Veterans Administration Hospital
VBP: Value-Based Purchasing
W
WC: Worker’s Compensation
WH: Withhold
WIC: Women, Infants and Children (supplemental food program)
Y
YTD: Year to Date
Have Health Insurance Questions?
We hope that this information on acronyms is helpful for you.
Insurance is oftentimes overwhelming, and we want to shed light on the industry by answering your questions. Comment below and your question may be the topic of our next post!
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