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 Procedura 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