Understanding & Getting Health Care Coverage
A health condition such as asthma, diabetes, or cancer, that you had before the date that your new health coverage starts.
What is a Pre-existing Condition?
General term for type of health insurance offered by an employer, union, or association to its members.
What is a Group Health Plan?
The Marketplace generally considers this to be you, your spouse if you are married, and your tax dependents.
What is Household?
Health insurance sold by private insurance companies to fill the “gaps” in Traditional Medicare Plan coverage.
What is a Medigap Policy?
Refers to use of a health care provider that has a contract with your health insurance plan to provide health care services to its plan members at pre-negotiated rates.
What is In-Network?
The annual period when individuals can obtain, renew, change, or cancel their health insurance.
What is Open Enrollment?
It gives some workers who lose employment the option to continue health insurance coverage for limited periods of time (usually 18 months).
What is the Consolidated Omnibus Budget Reconciliation Act or COBRA?
Formerly called the Kentucky Health Benefit Exchange, this is the online Marketplace through which you can purchase individual/family health insurance in the Commonwealth of Kentucky.
What is kynect?
Free health insurance for children younger than 19 without health insurance and are in families with incomes less than 213 percent of the federal poverty level.
What is The Kentucky Children's Health Insurance Program (KCHIP)?
A fixed amount you may be required to pay for office visits, pharmacy, emergency room, outpatient, or surgery visits prior to or after meeting your deductible.
What is a Copay?
It's the comprehensive health care reform law which was enacted in March 2010.
What is the Affordable Care Act or the ACA?
A type of savings account (sometimes offered by an employer) that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. You are able to lower your overall health care costs by using untaxed account dollars to pay for deductibles, co-payments, co-insurance, medications, and other qualified health care expenses. These funds generally may not be used to pay premiums. These accounts can be rolled over year to year and remain with the employee upon termination of employment. The funds may be invested and earn interest that is tax free.
What is a Health Savings Account (HSA)?
Caresource, Wellcare, Anthem, Passport
What are available kynect plans?
Insurance program that provides free or low-cost health coverage to qualified individuals and families with low incomes, including children, pregnant women, older people, and people with disabilities.
What is Medicaid?
The negotiated amount that a provider has agreed to be paid by the insurance company that providers for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
What is Allowed Amount?
A formal order from your primary care provider for you to see a specialist or get certain medical services.
What is a Referral?
A special account you and your employer can put money into that you use to pay for certain out-of-pocket health care costs. You do not pay taxes on this money. This means you will save an amount equal to the taxes you would have paid on the money contributed to this account. There is an annual cap on the amount that can be contributed by you or on your behalf. These accounts are considered “use it or lose it funds,” although a certain amount can be rolled over from one year to the next. Unused account funds are returned to the employer.
What is a Flexible Spending Account (FSA)?
Bronze, Silver, Gold, but not Platinum
What are the tiers of kynect plans?
This is the federal health insurance program for: people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.
What is Medicare?
The amount paid per month for an insurance policy.
What is a Premium?
A snapshot of a health plan's costs, benefits, covered health care services, and other important details about the plan.
What is Summary of Benefits and Coverage (SBC)?
An employer sponsored program that provides reimbursement for health care expenses such as premiums and out of pocket expenses.
What is an HRA?
A discount for Marketplace plans that lowers the amount you must pay for deductibles, copayments, and coinsurance.
What are Cost-sharing Reductions?
Also known as Medicare Part C, purchased from private carriers and serves as an alternative to Medicare Parts A, B, and sometimes D.
What is Medicare Advantage
A percentage amount of the allowed cost of your medical care that you are required to pay.
What is Co-insurance?