Glossary — Learn Insurance Terms and Phrases

Here are some terms that get thrown around whenever people are talking about insurance. There are some very basic ones — and some pretty advanced ones. Look around — hopefully it will give you a better sense of what the insurance companies are talking about.

  1. ALL
  2. A
  3. B
  4. C
  5. D
  6. E
  7. F
  8. G
  9. H
  10. I
  11. J
  12. K
  13. L
  14. M
  15. N
  16. O
  17. P
  18. Q
  19. R
  20. S
  21. T
  22. U
  23. V
  24. W
  25. X
  26. Y
  27. Z

SEP/QLE (Special Enrollment Period / Qualifying Life Event)

This is the only exception to the Open Enrollment rule.  If you have a QLE, you have a 60 day SEP to buy new individual health insurance or make changes to your existing plan.  Examples of QLE’s include marriage, divorce, birth of a child, moving to a new state, recent immigration to the US, loss of employer sponsored health insurance, COBRA running out, and more.  Please remember that ALL insurance companies are requiring paper documentation to prove your Qualifying Life Event (QLE).

SHOP

Small Business Health Option Plans.   SHOP is part of your state’s Exchange/Marketplace (in CA it’s Covered California), where small businesses (with under 50 employees) can shop for  group health insurance for their employees.    However, there is no requirement for small employers to provide any insurance at all.

Silver / Gold / Platinum / Minimum Coverage / Bronze aka Metallic Tiers

Post Obamacare, all health insurance companies have to offer the same metallic tiers.  You can purchase these plans directly from the insurance company OR from your state exchange – but always contact an experienced broker to help you figure it out!  All companies have to offer these policies without a lot of differences (which might vary slightly from state to state).  So when shopping for new plans,  it’s only about the company and their reputation, doctor network and drug formulary.

Single Payer

This model of health insurance creates one source of payment to providers, which could be State or Federal.   The State or Feds would collect taxes and federal funds then decided how to distribute payment to providers of medical services, and control when you can see your doctor and what services you could get.

Single Payer

A government run health care program.   A combination of federal funds, state funds, and (a lot of) taxpayer’s money to pay for medical services.

Skilled Nursing Facility

State licensed institutional setting which provides nursing and rehabilitative care provided by or under the direction of skilled medical personnel – available 24-hours a day & ordered by a physician under a treatment plan.

Socialized medicine

Aka universal health coverage, a government-run insurance system combined with private insurance policies.

Subsidies

As of 1/1/14, under the Affordable Care Act (ACA), this is the amount of help you will get from the federal government to help you pay for health insurance IF you qualify and only IF you buy health insurance through an online Exchange, aka Marketplace or in California known as Covered California.  Subsidies are also known as an Advance Premium Tax Credit (APTC).

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