Glossary

Affordable Care Act — A federal health care law that aims to improve our current health care system and increase access to health coverage for Americans by expanding coverage, removing barriers to coverage and addressing affordability.

annual out-of-pocket maximum — The maximum amount, per year, you are required to pay out of your own pocket for covered health care services after the deductible is met.

claim — An itemized bill for services that have been provided to a subscriber, a subscriber's spouse or dependents.

copayment — A fixed dollar amount you are required to pay for covered services at the time you receive care.

covered service — A service which is covered according to the terms in your health care benefits plan.

dependent — An eligible person, other than the member (generally a spouse or child), who has health care benefits under the member's policy.

Health Insurance Portability and Accountability Act (HIPAA) — A federal law that outlines the rules and requirements employer-sponsored group insurance plans, insurance companies and managed care organizations must follow to provide health care insurance coverage for individuals and groups.

Health Risk Assessment (HRA) — An assessment of a health care plan member's health status by taking into account that person's family health history and health-related behaviors to predict the member's likelihood of experiencing certain health issues.

individual coverage — Health care coverage for an individual with no covered dependents.

inpatient services — Services provided when a member is registered as a bed patient and is treated as such in a health facility such as a hospital.

maximum annual benefit — The maximum dollar amount your health care plan will pay for health care services provided to you during one year.

member ID — A unique number that identifies you as a member of a certain health care plan (also known as an ID number or subscriber ID).

network — The group of doctors, hospitals and other medical care professionals that a managed care plan has contracted with to deliver medical services to its members.

out-of-pocket maximum — The maximum amount you must pay for expenses covered under your health care plan, after any deductible is met, during a defined benefit period.

outpatient services — Treatment that is provided to a patient who can return home after care without an overnight stay in a hospital or other inpatient facility.

pre-existing condition — A health condition for which an individual received medical care during a specified period of time immediately prior to the effective date of coverage.