Glossary

• A
• B
• C
• D
• E
• F
• G
• H
• I
• J
• K
• L
• M
• N
• O
• P
• Q
• R
• S
• T
• U
• V
• W
• X
• Y
• Z

A

• ACA Insurer Tax
• Accountable Care Organization (ACO)
• Actuarial Value
• Administrative Services Only (ASO)
• Affordable Care Act
• Alternative Funding Arrangements
• Appeal

B

• Balance Billing
• Balanced or Level-Funding
• Behavioral Health Services
• Benefit Buy-Down
• Broker
• Bundled Payment

C

• Carrier Profitability
• Carrier Solvency
• Catastrophic Loss
• Claim
• Co-Insurance
• Co-Payment
• Consolidated Omnibus Budget Reconciliation Act (COBRA)
• Consumer Assessment of Healthcare Providers and Systems (CAHPS)
• Consumer-Driven Health Care
• Contingent Premium

D

• Deductible
• Disease Management Programs
• Dividend-Eligible Funding
• Downside Risk Contract

E

• Eligibility
• Evidence-Based Guidelines
• Excluded Services
• Explanation of Benefits (EOB)

F

• Fee For Service
• Fee For Service
• Fee For Service
• Financial Ratings Organizations
• Fixed Costs
• Flexible Spending Account (FSA)
• Formulary
• Fully-Insured (FI)

H

• Health Care Provider
• Health Maintenance Organization (HMO)
• Health Reimbursement Account (HRA)
• Health Savings Account (HSA)
• High deductible health plan (HDHP)

I

• In-Network
• Incurred Claims
• Indemnity Plan
• Inpatient Care

L

• Loss Ratio

M

• Medical Case Management
• Medical Cost Drivers
• Medically Necessary
• Member Contribution
• Metal Levels
• Minimum Essential Coverage (MEC)
• Minimum Value Standards

N

• National Association of Insurance Commissioners (NAIC)
• Network Adequacy
• New Hampshire Insurance Department
• New Hampshire's Federally Facilitated Health Insurance Marketplace
• New Hampshire's State Continuation Law

O

• Open Enrollment
• Out-of-Network
• Out-of-Pocket Costs
• Out-of-Pocket Maximum
• Outpatient Care

P

• Patient Centered Medical Home
• Pay-For-Performance
• Preauthorization
• Preferred Provider Organization (PPO)
• Premium
• Premium Tax
• Premium Tax Credit
• Preventive Services
• Price Transparency
• Primary Care Provider (PCP)
• Provider Discounts
• Provider Network

Q

• Qualifying Life Event

R

• Referral
• Risk Charge
• Risk Contracts

S

• Self-Insurance (SI)
• Self-insured (SI) Plan
• Small Group
• Special Enrollment Period
• Specialist
• State Benefit Mandates
• Stop-Loss Attachment Point
• Stop-Loss Insurance
• Substance Use Disorder
• Summary of Benefits and Coverage Document
• Summary Plan Description

T

• Third Party Administrator (TPA)
• Triple Aim

U

• Underwriting Gain
• Underwriting Loss
• Upside Risk Contract

V

• Value-Based Payment (VBP)

W

• Wellness Services