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ACA Basics
The Numbers
Plan Designs and Exchange
How do I measure up?
Random ACA Facts
100
A set of 10 (ten) health care service categories that must be covered by certain ACA plans.
What are Essential Health Benefits (EHBs)?
100
What a consumer pays monthly for health insurance.
What is a premium?
100
A managed care plan where services are covered ONLY if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
What is an Exclusive Provider Organization (EPO)?
100
SRA and one other federal contractor were awarded contracts to provide enrollment services through this type of staff.
What is an In-Person Assister?
100
March 23, 2010
What is the date that the ACA was signed?
200
They developed and approved the Federal Computer-Based Trainings (CBTs) for federal certification as an In-Person Assister (IPA).
What is the Center for Medicare & Medicaid Services (CMS)?
200
Your share of the costs of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.
What is coinsurance?
200
A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
What is a Preferred Provider Organization (PPO)?
200
Staff that is funded through federal grants and foundations
What are Navigators and others such as CACs (certified application counselors)?
200
Commonly referred to as CBTs
What are Computer-Based Trainings?
300
A score of 80% or better
What is required to pass a CBT module?
300
A fixed amount (for example, $15) the consumer pays for a covered health care service, usually when they get the service.
What is a copay?
300
A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the plan. It generally won't cover out-of-network care except in an emergency.
What is Health Maintenance Organization (HMO)?
300
Commonly referred to as an EAC
What is an Enrollment Assistance Center?
300
Commonly referred to as the EAP
What is the Enrollment Assistance Program?
400
Services like flu shots and screening tests provided at no cost to you under the ACA
What are Preventative Services?
400
The amount you owe for covered health care services before your health insurance plan begins to pay.
What is your deductible?
400
An insurance plan that is certified by the Health Insurance Marketplace, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements.
What is a Qualified Health Plan (QHP)?
400
The facilities, providers and suppliers your health insurer or plan has contracted with to provide health care services.
What is a Network?
400
Consists of those 18 – 34 years old, Individuals & families with household incomes between 138% and 400% of FPL, underserved urban minorities, and small businesses.
What is SRA's EAP Target Demographic?
500
A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
What is a formulary?
500
The most you’ll have to pay for covered services in a policy period (usually one year). After you reach this amount, your health plan will pay 100% for covered essential health benefits.
What is out-of-pocket maximum? (OOP max)
500
The time that EACs are open.
What is "during open enrollment periods"?
500
Referred to by the abbreviation ACA
What is the Affordable Care Act?
500
The cost for help at SRA's EACs
What is FREE of charge?