If you’re new to health insurance, chances are you’ve been running across a lot of acronyms and words that don’t make sense. Without any prior knowledge of the insurance industry, simple terms like HLV, ACA, and COI look like a bunch of scrambled letters. It doesn’t stop there, other words in the insurance business have just as much confusion behind them. In this article, I would like to cover some of the most common health insurance terms you might hear in the field and what it could mean for you.
Affordable Coverage & ACA
The first word you might have heard before is Affordable Coverage, which means that the employee’s required contribution for self-only coverage does not exceed a certain percentage of their household income. Another word that comes to mind and also causes confusion for people is ACA. A lot of people don’t know it by its formal name; rather, they know ACA by the slang term, Obamacare. The Affordable Care Act was the legislation passed in 2010 that changed how Americans enroll in and receive health care coverage. It’s important to remember that ACA and Obamacare are synonomous.
PPO & HMO
Have you seen or heard the acronym PPO? It means Preferred Provider Organization. A PPO health plan helps create contracts with medical providers creating a network of doctors and hospitals. Consequently, using the providers (hospitals & doctors) in this network will decrease the cost for visits and other needs.
Along the same lines is an HMO, which stands for Health Maintenance Organization. An HMO plan is a type of health insurance plan that limits coverage to care from doctors who are contracted with the HMO. Generally, it doesn’t cover out-of-network care, except for emergencies. In some cases, an HMO may require the policyholder to live or work in its network area to be eligible for coverage.
OEP & SEP
Every fall, there is what’s know as an Open Enrollment Period, or OEP. It is during this time that people can enroll in a new qualified health plan that meets the requirements of the Affordable Care Act (read more about this below). This year the enrollment period is only 6 weeks, starting November 1st and end December 15th.
If you’re trying to get insurance outside of open enrollment, you should check to see if you have a QLE to be able to register. Qualifying Life Events (QLE) are big changes in your life that make you eligible for a Special Enrollment Period or SEP.
Pre Existing Conditions & Qualified Health Plans
Trying to get coverage can be hard with a pre-existing condition. Simply put, a pre-existing condition is a health problem you had before the date that your new health coverage starts. Under the ACA, pre-existing conditions are void, giving everyone equal cost. Each insurance plan must be a Qualified Health Plan before being certified by the Health Insurance Marketplace. A Qualified Health Plan provides essential health benefits. Additionally, it follows established limits on cost-sharing and meets other requirements under the Affordable Care Act.
Since insurance is often times overwhelmingly confusing, we want to shed light on this industry by answering YOUR questions. So if you have any questions or concerns, comment below and your question may be the topic of our next video!
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