Glossary of Terms

A - D

AB1672 Legislation: (See ACA/ Affordable Care Act)  A California assembly bill designed to educate small business owners of group health insurance. In 1993 the assembly bill was passed and enacted that effected the way health insurance carriers treated small businesses. Carriers such as Blue Cross of California, Blue Shield of California, Sharp Health Plan, Health Net, Kaiser, Aetna, Cigna and PacifiCare and many others accept groups of 2 or more. Carriers must accept all small businesses that apply for plans regardless of the nature of the firm's business or the health
conditions of its employees. Depending on the health questions and size of the group the premium can range from 95% to 110% of published premium. These published premium charges are submitted and filed with the Department of Corporations. Many carriers will automatically assign a rate of 110% for groups with fewer than 5 employees. (For more information on the bill go to www.insurance.ca.gov)  The ACA (Affordable Care Act) replaced much of this legislation in 2013.

Accidental Injury: Definite trauma resulting from a sudden, unexpected and unplanned event, occurring by chance, caused by an independent external source.

Activities of Daily Living (ADL): the self-care and mobility skills required for independence in normal everyday living. This does not include recreational or sports activities. (Bathing, eating, dressing, transferring from bed to chair, toileting, continence or severe cognitive impairment)

Acute Care: care rendered in the course of treating an illness, injury or condition marked by a sudden onset or change of status requiring prompt attention, which may include hospitalization.  It is limited in duration and is not expected to last indefinitely.

Adult Day Care: Community centers provide different levels of medical care and therapy, along with meals, companionship, activities and social services. They center offers the family aregivers an alternative to using full-time providers at the home.

Annual Benefit Limit:  In the past, some insurance plans have place a limit on the dollar amount of claims they will pay in a given year for an individual.  Beginning in 2010, annual benefit limits on certain "essential health benefits" are restricted on a graduated basis, and annual limits will eventually be prohibited in 2014.A

Annuity: A contract issued by an insurance company that offers the systematic liquidation of principal over a selected period, including payments guaranteed to last for the lifetime of the annuitant. Guarantees are backed by the claims paying ability of the issuer, annuities are long term investments designed for retirement purposes. Withdrawals of taxable amounts are subject to income tax and, if taken prior to age 59 1/2, a 10% federal tax penalty may apply. Distributions may start as early as 59 1/2 years of age or by age 70 1/2.

Annuity (Fixed): Specifies a fixed rate of interest (usually set annually based on the prevailing market interest rates) that will be paid on the amount invested in the annuity. The insurance company assumes the investment risk. Most fixed annuities provide a guaranteed minimum rate of interest for the life of the contract. Guarantees are backed by the claims paying ability of the issuer, annuities are long term investments designed for retirement purposes. Withdrawals of taxable amounts are subject to income tax and, if taken prior to age 59 1/2, a 10% federal tax penalty may apply.

Annuity (Equity-Indexed): Also known as an EIA. An annuity that offers both a guarantee of principal and earnings linked to the upside movement of an equity index.

Annuity (FPDA): Flexible contributions may be made as often and in whatever amounts the contract owner desires; benefits begin one year from the date of purchase. Deferred annuities are normally purchased to defer taxes on growth and accumulation, such as a retirement fund. This annuity is also ideal for educational funding.

Annuity (SPDA): A single premium (lump sum) is put into an account from which the annuitant will draw the periodic benefits (funds) at some specific time in the future. Benefits begin more than one year from the date of purchase. This annuity may be ideal for educational funding.

Annuity (SPIA): A single premium (lump sum) is put into an account from which the annuitant may immediately begin drawing benefits (funds). Funds to be drawn with a year of issue. The immediate annuity essentially does not have an accumulation period.

Annuity (Annuitization Options):
1. Term Certain: Benefit payments received for a specified period of time, or until death; whichever comes first.
2. Life Income: Benefit payments for as long as the annuitant lives, and upon death all payments cease (pays more monthly income than any other option).
3. Life Income Period Certain: Benefit payments for life, or for a specified period, whichever occurs last. If the annuitant lives beyond the period, the benefits continue for life.
4. Life Income with Refund (fixed amount or cash refund): Benefit payable for the lifetime of annuitant. Upon his/her death, if annuitant has not received an amount equal to the total of all payments made into the annuity, the balance is refunded to the beneficiary either a lump sum or in installments.
5. Fixed Amount (Level Benefit): Pays an amount as stated by the annuitant for as long as the principal and interest will pay the set or level benefit.
6. Life Income Joint & Survivor: Benefit payable to two or more annuitants while both are living. Upon death of the first annuitant, survivor benefits continue, normally reduced to two-thirds or one-half for the survivor's income until the survivor dies. Joint and two-thirds life annuity is considered a full annuity for a married couple.
7. Joint Life: Benefit payable to two or more annuitants while both are living. Upon the death of the first annuitant, the benefits stop.

Appeal: A process used by a member to request the health plan re-consider a previous authorization or claim decision.

Basic Health Plan:  Beginning in 2014, states will have the option of creating a basic health plan to provide coverage to individuals with incomes between 133 and 200 percent of poverty instead of enrolling in the health insurance exchange and receiving premium subsidies.  The federal government will provide states that choose to offer this plan with 95 percent of what it would have paid to subsidize these enrollees in the health insurance exchange. A

Basic Medical Policy: May also be referred to as a "catastrophic" policy. After deductible is met will cover hospital, surgical, and inpatient services for x-ray, laboratory, and prescription.  These policies usually have a deductible, co-insurance clause, and a stop loss limit.

Brand Name Drug: A prescription drug which is protected by a trademark registration.

CHIP:  The Children's Health Insurance Program (CHIP) is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to low income familes with children.  The program was designed with the intent to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid.  A

Chronic Care: care (different from acute care) furnished to treat an illness, injury or condition, which does not require hospitalization, which may be expected to be of long duration without anyreasonably predictable date of termination, and which may be marked by occurrences requiring continuous or periodic care as necessary.

COBRA:  Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) applies to employers who generally employ 20 or more full time equivalent employees.  Employees who lose their jobs are able to continue their employer-sponsored coverage for a set period of time.  For example, employees are typically entitled to extend coverage for 18 months, however if they are deemed disabled by the Social Security Administration, coverage may continue for up to 29 months.   

Coinsurance: The percentage of allowable costs you pay for covered health care services after you satisfy your annual deductible; amounts vary by plan.

Community Living Assistance Services and Supports (CLASS) Program:  The CLASS program establishes a national voluntary long-term care insurance program for the purchase of non-medical services and support necessary for enrollees who have paid premiums into the program and become eligible (due to disability or chronic illnesses).  Enrollees who receive benefits that help pay for assistance in the home or in a facility in future years.  Enrollment begins January 1, 2011 (targeting working adults who can make voluntary premium contributions through payroll deductions or directly).  The first benefits will be paid out to enrollees in 2016. A

Comprehensive Major Medical Policy: Combines the best features of the Basic policies and Major Medical policy into a single policy. This includes hospital coverage and "reasonable and necessary" medical expenses. These policies usually have a deductible, coinsurance clause, and a stop loss limit.

Consumer-Directed Health Plans:  These health plans seek to increase consumer awarness about health care costs and provide incentives for consumers to consider costs when making health care decisions.  These plans usually have a high deductible accompanied by a savings account for helath care services .  There are two types of savings accounts:  Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs). A

Co-Payment: The specific dollar amount or percentage required to be paid by or on behalf of a member in connection with an insurance benefit.

Custodial Care (or Maintenance Care): Care furnished in home primarily for supervisory care or supportive services, or in a facility primarily to provide room and board (which may or may not include nursing care, training in personal hygiene and other forms of self care or supervisory care by a doctor of Medicine).

Deductible: An amount that a member must pay for covered services each year before the plan begins paying part of the costs.

Dependent: A person who is eligible to be enrolled for coverage under a member or subscriber's
plan. Examples would be a subscriber's spouse or child. Health Care Reform Law (2010) states that a dependent child can continue on the parents medical plan until age 26.  The dependent does not have to be in college, live at home or be financially dependent upon the parent. 

Dependent Care Account: A savings account to offset cost of child care. A maximum of $5000 can be set aside annually pre-tax from payroll check. Consult tax guidelines if this is ideal or if you should file deduction upon filing your taxes.

Disability: 1a. The condition of being disabled. 1b. The inability to pursue an occupation because of a physical or mental impairment.  An occupational disability consists of an injury or sickness that was caused on the job.  A non-occupational disability consists of an injury or sickness that occurred while off the job.

Disability Insurance: A contractual agreement that provides a portion of income if the individual becomes disabled from an injury or sickness on or off the job. Types: short-term (considered less than 90 days) long-term (considered more than 90 days), state or federal programs, group or individual plans.

Domestic Partner: A person considered a lawful or documented dependent of the subscriber and dependent upon the individual for support. For some types of insurance coverage the appropriate documentation (a notarized affidavit or, for same-sex domestic partners, a Declaration of Domestic Partnership filed and stamped by the Secretary of State).

Donut Hole:  A gap in prescription drud coverage under Medicare Part D, where beneficiaries pay 100% of their prescription drug costs after their total drug costs exceed an initial coverage limit until they qualify for a second tier of coverage. Under the standard Part D benefit, Medicare covers 75% of drug costs below the initial coverage limit ($2830 in 2010), and 95% of spending with the second tier level ($6440 in 2010).  The "donut hole" specifically refers to the range between these two levels.  Health care reform also provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010, increases discounts in subsequent years and completely closes the donut hole by 2020. 

E - J

Electronic Health Record/Electronic Medical Records:  Computerized patient health records, including medical, demographic, and administrative information.  These records can be created and stored within one organization or shared across multiple health care organizations and sites. A

Eligible Employee: A permanent employee who works either full-time (at least 30 hours) or part-time (between 15 - 29 or 20 to 29 hours) and has a normal work schedule. They must be compensated for the work by their employer (subject to withholdings appearing on a W-2 form).
Sole Proprietors/Partners/Corporate Officers are eligible and must work at least 20 hours per week.
Others: Seasonal workers within the agricultural industry, and private household staff may be considered eligible though subject to underwriting approval.

Employee Retirement Income Security Act of 1974 (ERISA):  Enacted in 1974 to provide minimum Federal standards for welfare benefit plans in private industry, and protect the interests of employee benefit plan participants and their beneficiaries by requiring the disclosure to them of financial and other information concerning the plan; by establishing standards of conduct for plan fiduciaries; and by providing for appropriate remedies and access to the Federal courts.A

Employer Mandate:  Beginning in 2014 pursuant to the health reform law, employers meeting size or revenue thresholds will be required to offer minimum essential health benefit packages or pay a set portion of the cost of those benefits for use in the Exchanges.A

Essential Health Benefits:  The health reform law placed certain coverage requirements on essential health benefits, and provides a broad set of benefit categories that would be considered essential to a health benefits package -- including hospitalization, outpatient services, emergency care, prescription drugs, maternity care, preventive services and other benefits.  The secretary of HHS will, in the future, define what constitutes "Essential Health Benefits" and this will be guided by the current scope of benefits provided under a typical employer plan.  For plan years beginning in 2020 the only requirement for "Essential Health Benefits" is that if they are included in the plan they may not be subject to lifetime limit and until 2014 can only be subject to a "restricted annual limit". A 

Exchange or Health Insurnace Exchange:  The health care reform law creates Health Benefit Exchanges (competitive insurance marketplaces) in each state, where individuals and employer can shop for health plans. A

Explanation of Benefits (EOB): A form provided to members to explain how the payment amount for a health benefit claim was calculated.

Flexible Spending Account: A type of cafeteria plan authorized under Section 125 of the Internal Revenue Code. Separate FSAs can be set up to cover expenses such as health insurance premiums (POP), qualified medical expenses or dependent care expenses. There are no specific health plan requirements. An employee or employer can contribute to the account on a pre-tax basis.

Unused FSA balances are forfeited at the end of the year. (Note: New legislation in May 2005 issued y the U.S. Department of Treasury (2005-42) allows employers to modify FSAs in order to extend the deadline for reimbursement from accounts. The deadline can be extended by up to 2 1/2 months, at the employer's discretion. Still pending is legislation to allow $500 to be rolled over. For more information to go http://www.treas.gov/press/releases/reports/n9542.pdf.

Formulary (Drug Formulary): A listing of prescription drugs and insulin established by the health plan which includes both Brand Name and Generic Prescription Drugs. These drugs are subject to copayments that may vary based on the plan design.

Generic Drug: A prescription drug which is not protected by trademark registration, but is produced and sold under the chemical formulation name.

Grandfathered Plan:   A health plan that was in place on March 23, 2010, when the health reform law was enacted, is exempt from complying with some parts of the health reform law, so long as the plan does not make certain changes (such as eliminating or reducing benefits, increasing cost-sharing, or reducing the employer contribution toward the premium). Once a health plan makes such a change, it becomes subject to other health reform provisions (e.g. appeals and cost sharing restrictions on preventive services). A

Health Maintenance Organization (HMO): A third party, usually a legal entity, which arranges payment for the provision of basic and supplemental health services to its members from a network of independently contracted providers and facilities on a prepaid or reduced fee basis. Members are required to select a primary care physician to provide routine care, and provide referrals for specialty and hospital services when appropriate.

Health Reimbursement Arrangements (HRA): An employer funded account that reimburses employees for qualified medical care expenses. This arrangement is usually combined with a high deductible health plan.

Health Savings Account: A savings account or trust account created by the Federal Government (under 2004 Medicare Legislation) that are designed to help individuals save for today's and tomorrow's medical expenses on a tax-free basis. Each state may choose to comply with the federal guidelines or establish their own guidelines concerning the state treatment of HSAs.
An individual must have a compatible Qualified High Deductible Plan. An individual or employer may contribute to this account. Interest may accrue on the account. Funds may roll over each year.

High-Risk Pool:  The health reform law expands upon the current state-based high-risk pool system.  The law requires the government to establish or issue contracts to establish a temporary high risk pool (through 2013) to provide coverage for eligible individuals with pre-existing conditions by appropriating $5 billion to subsidize premiums.  Eligiblility is limited to individuals who have been uninsured for at least six months prior to applying for pool coverage, and who have a pre-existing condition. A

Home Care: Is the provision of preventive, supportive, rehabilitative, or therapeutic health care in a home setting. It also includes supportive supportive social services such as homemaker and personal care services.

Home Health Care: Skilled medical care for the seriously ill, injured or dying at the home provided by a nurse, therapist, certified nurse's aid or other licensed health care professional. A home maker/ home health aids are an invaluable part of this team. Home health care covers the use of assistive devices (crutches, canes, walkers, IV setups, hospital beds, wheelchairs, ostomy supplies, prostheses, and oxygen). Also look at Durable Equipment benefits.

Hospice Care: Care received under a program that is:
1. Designed to provide comfort and supportive care to individuals who have received a diagnosis of Terminal Illness.
2. Supportive to covered family members by providing certain services listed under the Home Health Care, Home Hospice, and Home Infusion Care benefit.
3. Licensed or certified in jurisdiction where the program is established.
4. Directed and coordinated by medical professionals.

HIPAA: Is a federal law enacted in 1996. It is designated to improve availability and portability of health coverage by:
- limiting exclusions for pre-existing conditions;
- providing credit for prior health coverage;
- allowing transmittal of coverage information to a new issuer;
- providing new rights to allow individuals to enroll for health coverage when they lose their health coverage or have a new dependent;
- prohibiting discrimination in enrollment/premiums;
- guaranteeing availability of health insurance coverage for small employers.
HIPAA's Administrative Simplification and Privacy (AS& P) Act final rules took effect in April 2001. The purpose of these rules is to improve the efficiency of health care system by standardizing the electronic exchange of health information and protecting the security and privacy of member-identifiable health information.

Individual Mandate:   A requirement that most individuals obtain health insurance or pay a penalty beginning in 2014.  Masachusetts was the first state to impose an individual mandate that all adults to have health insurance.A

Individual Retirement Accounts (IRA): Anyone under the age of 70-1/2 who has earned income may open an IRA. Contributions grow tax-free until they are withdrawn. Maximum annual contribution allowed by IRS is $3000 (2001-2004), $4000 (2005-2007), $4500 (2008-2009), $5000 (2010-2011). Distributions must start by age 70-1/2 or incur a 50% excise tax. Premature distributions before age 59-1/2 will incur a 10% penalty tax. (See Rollover)

Ineligible Employees: Individuals considered temporary, leased or substitute workers and persons compensated on a 1099 basis.

Insurance:  1. An insuring or being insured. 2. Contract (insurance policy) whereby a person or company guarantees payment for a specified loss by fire, death, etc. 3. The amount for which something is insured. 4. The business of insuring against loss.

IPA (Independent Practice Association): A group of providers that contract with managed care plans while maintaining their separate practice.

L - P

Life Insurance: A contractual agreement providing insurance of payment for a stipulated sum to a designated beneficiary upon the death of the insured. Types: Term, Universal, Whole.

Lifetime Benefit Maximum:  A limit on the amount an insurer will pay toward the cost of health care services over the lifetime of the policy.  Health care reform prohibits lifetime dollar limits on "essential health benefits" effective for plan/policy years beginning on or after September 23, 2010. A

Long-Term Care (LTC): Long-term care is the daily assistance necessary when one contracts a serious disability that lasts for a period of time, and they are not able to care for themselves.  Types of care include: home health care, home care, adult day health care, respite care, assisted living facilities, skilled nursing facilities and hospice services. (See also the Community Living Assistance Services and Support program defined above.)

Long-Term Care Insurance: Is the business of insuring against the loss of one's ability to function independently in society whether it be due to an injury or sickness or through the natural progression of growing old and/or becoming frail.

Medicaid / Medi-Cal: Provides increased assistance to those with a financial need and unable to pay for their medical needs. Medicaid is a federal and state administered program. Medicaid pays for hospital care, outpatient care, certain nursing facilities, doctors, laboratory, x-ray services, prescriptions, Long-Term Care, and some home health care after current assets are exhausted.

Medicaid (update Health Care Reform):  A federal and state funded program that provides medical and health related services to certain low-income Americans.  The HCR law expands Medicaid eligibility to non-Medicare eligible individuals with incomes up to 133% of the Federal poverty level, establishing uniform eligibility for adults and children across all states by 2014. A

Medicare: Is a federal administered program developed by Congress in 1965 as an amendment to the Social Security Program. It is not designed for a specific class of society, but primarily for our citizens age 65 and older. Others of any age who received Social Security disability benefits for at least two years are eligible. Medicare is a federal health insurance program. There are two traditional parts to the program: Part A- Hospital Insurance and Part B- Outpatient Medical Insurance. For more information go to www.medicare.gov.

Medicare Advantage: Formally known as Part C. Is available from all the major health insurance carriers. It is designed as an affordable HMO plan and the member assigns their benefits over to the medical facility that will do all the billing to Medicare. Added benefits may be offered from the insurance provider such as a routine eye exam, allowance for lenses and frames, gym membership, hearing aid allowance, transportation, a limited dental plan, and chiropractic services.

Medicare Enrollment Periods: A) Initial Enrollment Period lasts 7 months, and begins on the first day of the third month before your 65th birthday and ends on the last day of the third month following the month in which one is eligible. B) General Enrollment Period is a period from January 1 to March 31of each year in which one can enroll for Medicare if he/she did not enroll during their initial enrollment period. C) Annual Enrollment Period is a period from October 15 to December 07 in which existing beneficiaries can make changes to their MAPD and Part D plans.

Medicare Supplement Insurance: Also known as Medi-Gap. This is health insurance offered by private insurance companies to fill the "gaps" in the original Medicare Plan coverage of Part A and Part B. These supplements give you power of choice and the flexibility to choose any doctor or hospital that accepts Medicare. ( 10 standard plans: A - J. H, I, and J have a drug benefit. A new supplement with a drug benefit will be available January 2006.) (2010 modernized plans were developed C, G, F, F+, K, L, M, N. The following plans are no longer available for sale E, H, I, J and prescription cover is no longer a component of these supplemental plans.)

National Association of Health Underwriters (NAHU): National and regional organization that provides education programs for insurance agents.  Also lobbies for health care reform.

Negotiated Fees: Discounted fees for medical services that have already been agreed upon by the insurance carrier and in-network/participating providers.

Network: Physicians, hospitals and other health care providers who contract with a specific insurance carrier to participate in health benefit plans. Also see Primary Providers and Non-Participating Providers/Physician.

Non-formulary Drugs: A prescription drug that is not covered under the Drug Formulary.  Each plan design may have a provision for these drugs.

Non-Participating Provider: This term generally used to mean providers who have not contracted with a health plan to provide services at reduced fees. Also called Non-Preferred Care Providers or Out of Network Providers.

Occupational Therapy: Treatment to restore a physically disabled person's ability to perform activities such as walking, eating, drinking, dressing, toileting, and bathing.

Out-of-Pocket Maximum: The annual maximum out of pocket that member will have to pay for expenses covered under the health plan, excluding premiums. The maximum may be a coinsurance maximum or a copayment maximum. Generally the OOP amount is calculated by the sum of all paid deductible and copayment or coinsurance amounts. Some POS and PPO plans may have two types of OOP maximums for services in and out of the network. Once the member reaches the OOP maximum(s) the plan pays 100% of expenses for covered services. Note: A family OOP is 2 or 3 times an individual member's amount.

The health reform law, beginning in 2014, prevents an employer from imposing cost sharing in amounts greather that the current out-of-pocket limits for high-deductible health plans ($5,950 for an individual policy or $11,900 for a family policy in 2010).  These amounts will be adjusted annually.A 

Outpatient: Care provided in a clinic, emergency room, hospital or non-hospital surgical facility (SurgiCenter) without admission to the hospital or facility.

Outpatient Facility: Refer to Outpatient.

Outpatient Surgery: Surgical procedures performed that do not require an overnight stay in the hospital or ambulatory surgery facility. Such surgery can be performed in the hospital, a surgery center, or physician office.

Patient Protection and Affordable Care Act (PPACA):  Also referred to as the "health reform law" this Act begins the implementation of a staged set of rules with an initial effective date of March 23, 2010.  The law is intended to increase access to health care for more Americans, and includes many changes that impact the commercial health insurance market, Medicare and Medicaid.A 

POS: Point of Service Plan provides benefits for covered services received from both participating (primary) and non-participating providers. when you enroll in a POS, you choose a primary care physician (PCP) for general care except for emergency and direct access benefits.  You are responsible for copayment or coinsurance payments. Care received on a self-referred basis will be subject to higher out of pocket costs such as deductibles, coinsurance and balance billing. You are responsible for obtaining pre-certification for services provided by non-participating or non-network providers.

Preferred Provider Organization (PPO): Also known as Open Choice. Members may choose any licensed health care provider for covered expenses. They will have lower out of pocket expenses when they utilize participating providers (Primary Network or In-Network).  Members need not select a primary care physician to manage their care, and can self-refer to providers either in or out-of-network.

Primary or Preferred Provider: Physicians, hospitals and other health care providers who contract with a specific insurance carrier to participate in health benefit plans. They provide services at reduced fees. Also see Non-Participating Providers.

Premium Subsidies:  A fixed amount of money, or a designated percentage of the premium cost, that is provided to help people purchase health insurance.  The health reform law provides premium subsidies to individuals with incomes between 133% and 400% of the federal poverty level who purchase policies through the health insurance Exchanges, beginning in 2014.A 

Preventive Care: Primary services provided for the early detection of disease when no symptoms are present. (e.g. annual physical, pap smear, PSA test, laboratory testing for sexually transmitted disease and/or adult immunizations, colorectal screening, osteoporosis screening, well-baby examination, pediatric immunization, eye and ear screening,
mammogram, chest x-ray, FDA approved cervical cancer screening).  See Health Care Reform Preventive Care Benefits.

Q - Z

Respite Care:  Continuous care of the patient in the most appropriate setting for the primary purpose of providing temporary relief to the family from the duties of caring for the patient. (Covered under most Long-Term Care Plans.)

Rollover: Changing from one type of qualified retirement plan to another. IRS rollover guidelines permit a rollover to avoid taxation as an early withdrawal. Must be completed within a 60-day window. A direct rollover is from a trustee to trustee (nontaxable) and may only be completed once very 12 months.

Roth IRA: Is a nondeductible tax-free retirement plan established under the Tax Relief Act of 1997. Developed for single people with AGI income levels of $117,000 to $132,000 (2016) and for married couples filing jointly with a combined income of $184,000 to $194,000 (2016).  Contributions are not tax deductible as with a traditional IRA. Contribution period may exceed age 70 1/2. Go to IRS.gov/publications for more information.

Small Business Tax Credit:  The health reform law includes a tax credit equal to 50 percent (35% in the case of tax-exempt eligible small employers) for qualified small employers that provide health coverage to their employees.  The tax credit is available to employers with 25 or fewer empoyees with average wages of less than $50,000. A

Skilled Nursing Facility: A facility licensed by your State Health Services as a "Skilled Nursing Facility" or any similar institution licensed under the laws of any other state, territory or foreign country.

Tax Credit:   (HCR Law update) An amount that a person or business can substract from the income tax that they owe.  If a tax credit is refundable, the taxpayer can receive a payment from the government to the extent that the credit is greater than the amount of tax they would otherwise owe.A

Tax Deduction:   (HCR Law update)  An amount that a person can substract from adjsted gross income when calculating the taxes that they owe.  Generally, people who itemize deductions can deduct the porition of medical expenses, including health insurance premiums, that exceeds 7.5% of their adjusted gross income.  Under health reform, the threhold for deducting medical expenses increases to 10% in 2013 (this increase is waived for individuals 65 and older for tax years 2013-2016). A

Urgent Care Facility: A licensed facility manned by a physician and staff. They may provide medical services 24 hours 7 days per week. They may be a cost effective solution compared to an Emergency Room for an unexpected illness or injury that is not life threatening but requires immediate outpatient medical care that cannot be postponed.

Voluntary benefits: Plans offered to employees under Section 125 of the IRC also known as Cafeteria Programs. Voluntary plans allows the employer to expand their employee benefit programs without having to pay for it. The advantage are group rates, less underwriting, portable coverage, and payroll deduction. Plans: Accident, Critical Illness, Cancer, Medical Bridge, Short and Long-term Disability, Term & Universal Life, Long-term Care, Flexible Spending Accounts, Health Savings Accounts, Dependent Care Accounts.

NUMERIC

401K retirement program: A type of profit-sharing plan under which participants are given the option to receive their annual contribution in cash as currently taxable income or have the contribution credited to the plan, in which case the contribution will not be currently taxable as income. ($18,000 maximum contribution 2016, $6000 catchup for those 50+)

Sources for glossary terms:
- SITS, California Long Term Care, Insurance of the 21st Century "A Second Look"
CTQ 2000, A.D. Banker & Company Insurance Education, 2001
- 2004 California Annuities, Sandi Kruise Insurance Training, 2004
- California Life & Health, 2300 Edition, A.D. Banker & Company Insurance Education,
UNLH2300, 2003
- Issues & Answers Vol. 121, December 11, 2003, The Council for Affordable Health Insurance's
- Aetna.com/help/glossary.html                                                                                                                             - (A) Health Care Reform Glossary www.uhc.com/united_for_reform_center/health_reform_glossary.htm

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