Health Care Reform Glossary
Affordable Care Act; Health care reform law
A law that was passed in March 2010 to improve access to affordable health insurance for many Americans.
A maximum amount of money your health plan will pay for a particular service, or on the number of visits that the health plan will cover for a particular service in a given year. If you reach it, you must pay all health care costs for that particular service for the rest of the year.
At least for 2014, we’re not making any changes when it comes to your eligibility for coverage through a Lockheed Martin health plan. U.S. employees working a minimum of 1000 hours a year will still be eligible for coverage.
Reduced dollar amounts for health plan features like annual deductibles and co-pays that are available to some people who get their health insurance through the public Exchange. To be eligible for these reduced dollar amounts, the person buying the coverage must qualify based on the amount of his or her household income. These discounts generally are not available if you are eligible to enroll in a Lockheed Martin health plan.
The requirement that each company with at least 50 full-time equivalent employees must provide health coverage that includes at least a minimal amount of benefits that the health care reform law says must be included, at a price employees can afford.
Essential Health Benefits
These are a set of services that must be covered by certain health plans. These services include:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
All health insurance plans offered through the public Exchange must cover these services. State Medicaid plans must cover them too. Lockheed Martin health plans cover most of these benefits as well.
In addition, health plans cannot put a lifetime or annual dollar limit on benefits that are available for these services. Lockheed Martin health plans do not include lifetime or annual dollar limits on these benefits.
Federal Poverty Level (FPL)
The FPL is a measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits that are available as a result of the Affordable Care Act. The 2013 Poverty Guidelines can be located at: http://aspe.hhs.gov/poverty/13poverty.cfm
This part of the Affordable Care Act requires health plans to enroll individuals regardless of health status, age, gender, or other factors. Except in some states, guaranteed issue doesn't limit how much you can be charged if you enroll. Benefits-eligible employees have guaranteed issue for Lockheed Martin health plans.
A part of the Affordable Care Act that requires health plans to renew your policy as long as you continue to pay premiums. Except in some states, guaranteed renewal doesn't limit how much you can be charged if you renew your coverage. Benefits-eligible employees have guaranteed renewal of their coverage under Lockheed Martin health plans.
Health Insurance Marketplace/Affordable Insurance Exchanges
This is a service set up in each state where individuals and small businesses can buy affordable and qualified health insurance plans. The Exchanges will offer a choice of health plans that provide different levels of benefits and have different costs.
High-Cost Health Plan Excise Tax
A part of the Affordable Care Act that imposes a tax on employer plan sponsors and insurance companies that provide high-cost health plans that goes into effect in 2018. This tax encourages employers and insurance companies to offer plans that make premiums more affordable.
Individual Health Insurance Policy
This is coverage not tied to a person’s job. These policies are regulated under state law.
The rule under the Affordable Care Act that says you must have health insurance that meets basic minimum standards by January 1, 2014. If not, a tax penalty may apply. Enrollment in a Lockheed Martin health plan satisfies the individual mandate.
This is health insurance that is offered to an employee (and often to his or her family) by his/her employer.
This is a state-run health insurance program for low-income adults, families and children, pregnant women, the elderly, people with disabilities, and in some states, others who qualify. The federal government provides a portion of the funding for Medicaid and sets guidelines for the program. States decide how they design their programs, so Medicaid (and what it is called) varies state by state. The Affordable Care Act expands Medicaid eligibility in many states.
This is a federal system of health insurance for people over 65 years of age and for certain younger people with disabilities or end-stage renal disease (ESRD).
Minimum Essential Coverage
This is the type of coverage an individual needs to have to meet the individual mandate under the Affordable Care Act. You can get it from individual market policies, job-based coverage (including a Lockheed Martin health plan), Medicare, Medicaid, CHIP, TRICARE and certain other coverage.
These are your expenses for medical care that aren't reimbursed by your health plan. They include deductibles, co-insurance, and co-pays for covered services, plus all costs for services that aren't covered.
Out-of-Pocket Limit (OOP)
The OOP limit is the most you pay during the calendar year before your health plan begins to pay 100% of the allowed amount. This generally includes co-pays, annual deductibles and co-insurance payments. This limit never includes your premium, balance-billed charges from health care providers or health care your health plan doesn’t cover.
This is the amount that must be paid for your health insurance. You usually pay it weekly.
Routine services like screenings, check-ups, and patient counselling that help prevent illnesses, disease, or other health problems. Under the Affordable Care Act, you and your family may be eligible for some these services, with zero out-of-pocket costs.
(See Health Insurance Marketplace)
Qualified Health Plan
A plan that is certified by a public Exchange and provides essential health benefits, follows established limits on cost-sharing (like deductibles, co-pays, and out-of-pocket maximum amounts), and meets other requirements.
This is a form of financial assistance provided by the federal government. Under the Affordable Care Act, those who qualify can receive this assistance in the form of an advanced tax credit or cost-sharing discount when purchasing health insurance through a public Exchange.
This is the amount you may owe starting January 1, 2014, for every month you do not have health insurance. If you have a tax penalty, you will need to pay it to the IRS when filing your annual tax return. For instance, if you went without coverage from January through March in 2014, you would add up the monthly penalty for the three months you didn’t have coverage and pay it in 2015 when filing your 2014 tax return.
This is a program intended to improve and promote health and fitness, usually offered through the work place, but sometimes offered directly to those who enroll through an insurance company. These programs offer you premium discounts, cash rewards, gym memberships, and other incentives to participate. Some examples of wellness programs include programs to help you stop smoking, diabetes management programs, weight loss programs, and preventive health screenings.