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 pre-tax savings account for medical expenses, only available with high-deductible health plans. These accounts can earn interest and remain with the employee following loss or change in employment.
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 health care plan has agreed that providers will be paid 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 pre-tax account for eligible health expenses, but funds must usually be used within the year, also commonly known as "use it or lose it."
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)?
This type of plan allows employers to offer various benefits, such as health insurance, on a pre-tax basis to their employees.
What is Cafeteria Plan (Section 125 Plan)?
A discount for Marketplace plans that lowers the amount you must pay for deductibles, copayments, and coinsurance.
What are Cost-sharing Reductions?
Gap in Medicare prescription drug coverage (Part D). You enter the coverage gap when you and your drug plan have spent a certain amount for covered drugs. Once in the coverage gap, you will pay no more than 25% of the cost for covered generic and brand-name prescription medications until you have reached the catastrophic limit.
What is Donut Hole?
A percentage amount of the allowed cost of your medical care that you are required to pay.
What is Co-insurance?