Terms Defined: Commonly Used Acronyms in Health Insurance

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:


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


BOI: Bureau of Insurance


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


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 & 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


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


GEHA: Government Employees Health Association


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


ICU: Intensive Care Unit

IRF: Inpatient Reading Fee

ISO: International Student Organization


JCAHO: Joint Commission on the Accreditation of Hospital Organizations


LOS: Length of Stay

LPN: Licensed Practical Nurse

LTD: Long Term Disability


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


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


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&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


QHP: Qualified Health Plan

QLE: Qualifying Life Events


ROI: Release of Information

RX: Prescription


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


TEFRA: Tax Equity and Fiscal Responsibility Act of 1982

TPA: Third-Party Administrator

TRICARE: Managed Healthcare System for military families

TTY: Teletypewriter


UCC: Urgent Care Center

UCR: Usual, Customary, and Reasonable


VA Hospital: Veterans Administration Hospital

VBP: Value-Based Purchasing


WC: Worker’s Compensation

WH: Withhold

WIC: Women, Infants and Children (supplemental food program)


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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