Glossary

Here are some of the most common terminology.

1. ACA: Affordable Care Act – A comprehensive healthcare reform law enacted in 2010 to increase access to affordable healthcare coverage and improve the quality of healthcare.
2. Agent: An individual authorized to sell insurance policies on behalf of an insurance company.
3. Annual Enrollment Period (AEP): The designated period during which individuals can enroll in or make changes to their health insurance coverage through the Marketplace.
4. Annual Notice of Change (ANOC): A notice sent by Medicare Advantage plans to their members each year, outlining any changes in coverage, costs, or benefits for the upcoming year.
5. Beneficiary: A person or entity named to receive the death benefit of a life insurance policy or the proceeds of a health insurance policy.
6. Bronze: A metal tier category for health insurance plans in the Marketplace that offers lower coverage but lower premiums.
7. Cash Value: Some final expense insurance policies may accumulate a cash value over time, which represents a portion of the premiums paid that can be borrowed against or surrendered for a cash payout.
8. Chronic Condition Special Needs Plans (C-SNPs): A type of Special Needs Plan that focuses on providing care for individuals with specific chronic conditions, such as diabetes, heart disease, or cancer.
9. Claim: A formal request made by the policyholder or beneficiary to the insurance company for payment of benefits covered by the policy.
10. Coinsurance: The percentage of medical expenses that the insured is responsible for paying after meeting the deductible.
11. Copayment: A fixed amount paid by the insured for certain covered services at the time of service.
12. Cost-Sharing Reductions (CSR): Additional financial assistance provided to individuals and families with lower incomes to reduce out-of-pocket costs for healthcare services received through Marketplace plans.
13. Death Benefit: The amount of money paid to the beneficiary upon the death of the insured under a life insurance policy.
14. Deductible: The amount an individual must pay out-of-pocket before the insurance coverage begins to cover the costs of medical expenses.
15. Dual-Eligible Special Needs Plans (D-SNPs): A type of Special Needs Plan that provides coverage for individuals who are eligible for both Medicare and Medicaid.
16. Essential Health Benefits (EHB): A set of ten categories of healthcare services that must be covered by all Marketplace health insurance plans.
17. Estate Planning: The process of arranging for the distribution of one’s assets and planning for end-of-life expenses, including funeral costs and estate taxes.
18. Face Amount: The total amount of coverage provided by a final expense insurance policy, representing the death benefit paid out to the beneficiary upon the insured’s death.
19. Final Expense Insurance: Also known as burial insurance or funeral insurance, it is a type of life insurance policy specifically designed to cover the costs associated with a person’s funeral, burial, and other end-of-life expenses.
20. Formulary: A list of prescription drugs covered by a Medicare Part D plan.
21. Gold: A metal tier category for health insurance plans in the Marketplace that offers higher coverage but higher premiums.
22. Grace Period: A specified period of time after the premium due date during which the policyholder can pay the premium without the policy lapsing.
23. Health Insurance: Insurance coverage that pays for medical and surgical expenses incurred by the insured, providing protection against high healthcare costs.
24. Health Maintenance Organization (HMO): A type of Medicare Advantage plan that typically requires members to use a network of healthcare providers and may require a referral to see a specialist.
25. Incontestability Period: A specific period during which the insurance company can investigate and contest the accuracy of the information provided in the insurance application.

26. Individual Mandate: A provision of the ACA that required most individuals to have health insurance coverage or pay a penalty. The individual mandate was effectively eliminated starting in 2019, but some states may have their own individual mandates.
27. Insured: The person whose life is covered by a life insurance policy or who is covered by a health insurance policy.
28. Medicaid Expansion: A provision of the ACA that allows states to expand their Medicaid programs to cover more low-income individuals and families. Medicaid expansion eligibility varies by state.
29. Medicare Advantage (MA) Plans: Private health insurance plans approved by Medicare to provide Part A and Part B benefits. Also known as Medicare Part C plans.
30. Medicare Advantage Prescription Drug (MA-PD) Plans: Medicare Advantage plans that include prescription drug coverage (Part D) in addition to the Part A and Part B benefits.
31. Medicare Star Ratings: A quality rating system used by Medicare to assess the performance and quality of Medicare Advantage plans. Ratings are based on factors such as customer service, patient outcomes, and member satisfaction.
32. Metal Tiers: Health insurance plans in the Marketplace are categorized into metal tiers based on the level of coverage they provide. The tiers include Bronze (lowest coverage but lowest premiums), Silver, Gold, and Platinum (highest coverage but higher premiums).
33. Minimum Essential Coverage: The type of health insurance coverage that satisfies the individual mandate requirement. Most Marketplace plans and employer-sponsored plans qualify as minimum essential coverage.
34. Out-of-Network Providers: Healthcare providers, hospitals, and pharmacies that do not have an agreement with a specific insurance plan. Out-of-network services may have higher out-of-pocket costs for plan members.
35. Out-of-Pocket Maximum: The maximum amount the insured is required to pay for covered medical expenses in a given period. Once this amount is reached, the insurance company pays 100% of additional covered expenses.
36. Preauthorization: The process of obtaining approval from the insurance company before undergoing certain treatments or procedures.
37. Preferred Provider Organization (PPO): A type of health insurance plan that allows members to choose any healthcare provider, but provides incentives for using in-network providers.
38. Policyholder: The person who owns an insurance policy and is responsible for paying premiums.
39. Preferred Provider Organization (PPO): A type of Medicare Advantage plan that allows members to use both in-network and out-of-network healthcare providers, although out-of-network services usually have higher out-of-pocket costs.
40. Premium: The amount of money an individual pays to an insurance company to maintain an insurance policy’s coverage.
41. Premium Tax Credits: Financial assistance provided by the government to help individuals and families with lower incomes afford health insurance coverage purchased through the Marketplace. The tax credits are based on income and can lower monthly premium costs.
42. Prescription Drug Plan (PDP): Stand-alone plans offered by private insurance companies that provide Medicare Part D prescription drug coverage.
43. Pre-Existing Condition: A health condition that exists prior to obtaining health insurance coverage. Under the ACA, health insurance companies cannot deny coverage or charge higher premiums based on pre-existing conditions.
44. Qualified Health Plans (QHP): Health insurance plans offered through the Marketplace that meet certain standards and requirements set by the ACA. QHPs provide the essential health benefits and comply with consumer protections.
45. Riders: Additional provisions or benefits that can be added to an insurance policy to customize coverage based on individual needs (e.g., a critical illness rider or a waiver of premium rider).
46. Silver: A metal tier category for health insurance plans in the Marketplace that offers a balance between coverage and premiums.
47. Special Enrollment Period (SEP): A period outside of the Annual Enrollment Period when individuals may be eligible to enroll in or make changes to a health insurance plan due to certain qualifying life events.
48. Subsidized Coverage: Health insurance coverage obtained through the Marketplace that is eligible for premium tax credits and cost-sharing reductions based on income and other factors.
49. Term: The length of time an insurance policy provides coverage before it expires or needs to be renewed.
50. Term Life Insurance: A type of life insurance that provides coverage for a specific period (term) of time, typically 10, 20, or 30 years.
51. Trustee: A person or entity responsible for managing funds or assets held in trust for the benefit of others, such as a funeral trust or other estate planning arrangements.
52. Underwriting: The process used by insurance companies to evaluate the risk of insuring an individual and determine premium rates.
53. Universal Life Insurance: A flexible type of life insurance that combines a death benefit with a savings or cash value component and allows for adjustments in premium payments and death benefit amounts.
54. Waiver of Premium Rider: A rider that can be added to an insurance policy, allowing the policyholder to waive premium payments in the event of disability or other qualifying circumstances.
55. Whole Life Insurance: A type of life insurance that provides coverage for the entire lifetime of the insured and includes a savings or cash value component.