Your Healthcare Guide

23 Health Insurance Terms You Should Know

Individual mandate
The provision of the Affordable Care Act which requires uninsured people to buy health insurance or face a penalty.

Lifetime limits
A cap on the total benefits you may receive from your insurance company over your lifetime. The Affordable Care Act eliminates lifetime limits for essential health benefits. In 2014, insurance companies will not be able to impose yearly limits either.

Medicaid expansion
Government-funded health coverage for people with low incomes and people with disabilities. The program has expanded some of its eligibility requirements under the Affordable Care Act.

The Mental Health Parity Act is a federal law that requires health plans to provide mental health benefits that are equivalent to the plans medical benefits. MHPA applies only to employers with more than 50 employees.

Minimum essential coverage
The least amount of health insurance an individual must acquire to meet the Affordable Care Act's individual responsibility requirement and so avoid a penalty.

Preexisting condition
An illness or condition that existed before the start of a persons coverage under a group health plan. Thanks to the Affordable Care Act is that starting in 2014, insurance plans can no longer deny coverage or charge you more because you have a pre-existing health condition.

The amount of money you and/or your employer must pay to keep your health insurance current. It is usually paid monthly, quarterly or yearly.

Preventive services
The Affordable Care Act requires that preventive services be 100% covered by your health insurance plan. Examples of preventive services are mammogram screenings, colonoscopies, blood pressure screening, and vaccines.

Special enrollment
Joining a group health plan when certain work or life events occur, regardless of the plans regular enrollment dates. Generally, special enrollment is available when you, your spouse, or your dependents lose other coverage; when you marry; or when you have a child. The plan must give you at least 30 days to request special enrollment.

Summary of benefits and coverage
An easy-to-understand summary of your coverage which must be available from your health insurance plan under the Affordable Care Act.

Tax credit premium and advanced premium
A tax break to help you afford health coverage through the Marketplace.

Source: Adapted from the U.S. Department of Labors Health Benefits Advisor Glossary and the Health Benefits Advisor Glossary.
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