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Insurance coverage Acronym Reference Guide

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Health insurance policies are a fancy topic, but every one of the acronyms and abbreviations create the subject even more difficult. Whether you’re aiming to be aware of the latest developments in health reform law or trying to make sensation of your health plan documents, you’ll probably run into a number of these acronyms. Young children and can does not anybody can become a guru on health care insurance or health law, but everyone is able to view the issues significantly better using this helpful reference.

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ACA The Patient Protection and Affordable Care Act (also Affordable Care Act or Obamacare) (2010) is most essential alteration to the U.S. healthcare system because the passage of Medicare and Medicaid in 1965. The aim of the ACA would have been to raise the quality and affordability of medical insurance, lower the uninsured rate through both private and public coverage, decreasing the total cost of medical.
ADA The Americans with Disabilities Act (1990) prohibits discrimination against individuals with disabilities during the parts of employment, public accommodation, transportation, communications, and government services. In addition, it establishes equitable requirements for telecommunications services for the people requiring assistive devices and technology.
ADEA The Age Discrimination in Employment Act (1967) prohibits wage, hiring, advancement, along with other employment discrimination by employers and labor organizations against persons 4 decades of age or older.
ALE An Applicable Large Employer, as defined within the ACA, is any business or organization that employs generally 50 or even more large employees or full-time equivalents (FTEs), who work 30 or over hours weekly. Beneath the ACA, ALEs must offer insurance coverage to the employees or face a lack of success.
CFR The Code of Federal Regulations, published annually, contains the general and permanent rules published in the Federal Register from the various departments and agencies within the U.S. governing administration.
CHIP Children’s Medical care insurance Program. See SCHIP, State Children’s Insurance coverage Program.
CMS The Centers for Medicare & Medicaid Services is usually a federal agency that administers Medicare and regulates state stewardship of Medicaid and State Children’s Health insurance coverage Program (SCHIP) activities. (Formerly the Health-related Financing Administration, or HCFA.)
COBRA The Consolidated Omnibus Budget Reconciliation Act (1985) establishes the ideal of workers who lose their employer-provided many benefits to pick to go on them under specific situations. A covered lack of benefits might be triggered by job loss, reducing of hours worked, transition between jobs, death, divorce, together with other life events.
CRA The Civil Rights Act (1964) outlawed discrimination determined by race, color, religion, sex, or national origin, effectively ending segregation in schools, workplaces and also other public accommodations.
CRC The Civil Rights Center, section of the U.S. Department on the job (DOL), develops, administers, and enforces policies and operations referring to Title VI and Title VII from the Civil Rights Act (CRA).
DHHS The U.S. Department of Health insurance Human Services was established to safeguard the healthiness of Americans and provide essential human services-especially for at-risk populations. The DHHS consumes almost 1 / 4 within the federal budget and administers more grant dollars than any other federal agencies combined.
DOL The U.S. Department of Labor is often a cabinet-level department of your federal liable for wage and work hour standards, workplace safety, and unemployment insurance benefits. It includes the Bureau of Labor Statistics, which tracks and manages such metrics since the Consumer Price Index, employment/unemployment numbers, and workplace injury figures.
DOT The U.S. Department in the Treasury is surely an executive agency of the federal in charge of managing U.S. economic and companies. As stewards of the public treasury, the DOT is mainly responsible for both collecting and disbursing taxpayer funds. (Not too another agency, the U.S. Department of transportation, shares the same acronym.)
EAP An Employee Assistance Program is undoubtedly an employee benefit generates counselling along with services accessible to employees to help them deal with personal and family conditions may potentially change the performance of job duties.
EBSA The Employee Benefits Security Administration, section of the U.S. Department of employment (DOL), administers, regulates and enforces the provisions of Title I of your Employee Retirement Income Security Act of 1974 (ERISA). (Formerly referred to as a Pension and Welfare Benefits Program, or PWBA.)
EDI Electronic Data Interchange generally describes a specialized rule while in the Health insurance coverage Portability & Accountability Act (HIPAA>) that defines a collection of data transmission specifications to govern exactly how sensitive health information and facts are electronically transferred between personal computers.
EEOC The Equal Employment Opportunity Commission is a federal authorities agency that investigates claims of discrimination according to your race, color, national origin, religion, sex, age, disability, genetic information (or retaliation for complaining in regards to a violation) in an effort to enforce laws against workplace discrimination.
EGTRRA The Economic Growth and Tax Relief Reconciliation Act (2001) amended many parts of the inner Revenue Code (IRC), including income-tax-rates, estate and gift tax exclusions, and qualified and retirement plan rules. Often referred to as on the list of two “Bush tax cuts,” the provisions of EGTRRA were renewed by Congress this season.
EIC See EITC, Earned Taxes Credit.
EITC An Earned Income Tax Credit is really a federal tax subsidy for working individuals and families to reward and encourage work and offset federal payroll and income tax.
EO Equal Opportunity is usually a concept and official government policy aimed toward reducing and eliminating discrimination and promoting the employment/business prospects of minorities and traditionally under-served populations.
EOB An Explanation of Benefits is a statement generated by some insurance company to a health plan participant to itemize specific medical services who were provided and explain the exact amount which was paid for the participant’s behalf.
EOI Evidence of Insurability, sometimes called “fitness to acquire insurance,” is sometimes essental to insurers before issuing a long-term disability or life insurance policy. Generally produced after an extensive health check, EOI suggests that any insured would not represent a specialized risk for an insurer.
EPO An Exclusive Provider Organization is often a health plan that mixes some highlights of an HMO along with a PPO. As shown by your message “exclusive,” EPOs don’t generally cover care provided beyond the network. Like PPOs, they may not need an initial care physician’s referral to check out an experienced professional.
ERISA The Employee Retirement Income Security Act (1974) provides minimum standards for employee pension plans and establishes extensive regulations in connection with tax impact of transactions regarding employee benefit plans.
FFE A Federally Facilitated Exchange can be a medical care insurance marketplace for expanding heath care treatment coverage under the ACA. All marketplace functions with FFEs are performed by DHHS, over the federal government’s Healthcare.gov portal. FFEs contrast with state-based marketplaces, state-partnership marketplaces and federally supported marketplaces.
FICA The Federal Insurance Contribution Act (1935) established a tax paid by workers as well as their employers to afford Social Security and Medicare. Originally instituted included in the New Deal, FICA was expanded within the 1960s.
FMLA The Family and Medical Leave Act (1993) provides selection for covered workers to take unpaid, job-protected leave (with continuation of group insurance coverage coverage) for family and medical reasons such as the birth or adoption of your child, a life threatening medical condition in the worker’s family, and a qualifying exigency in connection with an active-duty service member from the worker’s immediate family. This software is run through the Wage and Hour Division on the U.S. Department of employment (DOL).
FSA A Flexible Spending Arrangement (also Flexible Spending Account), allows workers to contribute pre-tax dollars to a personal fund for usage for qualifying medical and/or dependent care expenses.
FTE A Full-Time Equivalent can be a ratio of employees to hours worked, helpful to calculate the number of virtual “employees” an institution has for the purposes of federal health regulations. For examples, when a company has four part-time employees who work 25 hours every week, the overall employee output is 100 hours each week, or 2.5 FTEs (according to a 40-hour workweek).
FUTA The Federal Unemployment Tax Act (1939) may be a benefit paid to workers who may have lost their jobs, gone Congress inside wake of the Great Depression. Generally in most states, there’s both circumstances and federal tax that employers must pay for every single worker to the payroll.
GINA The Genetic Information Nondiscrimination Act (2008) can be a federal statute which makes it illegal for businesses to discriminate in employment or the provision of many benefits according to genetic information, or at a proven or perceived genetic predisposition to cultivate an individual disease or condition.
GLBA The Gramm-Leach-Bliley Act (1999) sought to modernize financial services by requiring businesses including banks, organizations, investment advisors and insurance carriers to shield private consumer information. Regulations served as the partial repeal of the Glass-Steagall Act (1933), which place strict controls on specific varieties of corporate mergers.
HCE Highly Compensated Employee designation can speak to a a student no less than a five-percent ownership inside of a company, who receives a salary over a degree ($120,000 in 2015), or whose salary is from the top 20 % for the company. In accordance with IRS rules, benefits administrators end up being capable to persuade regulators that HCEs and NHCEs are treated exactly the same way.
HCFA Health Care Financing Administration. This agency has become renamed. See CMS, Centers for Medicare & Medicaid Services.
HCTC A Health Coverage Tax Credit is definitely an IRS tax credit for insurance coverage premiums that helped spend on heath care treatment for qualified recipients between 2002 and 2013. Because the legislation that provided HCTC expired in 2013, go with wooden longer available for a credit.
HFSA A Health Flexible Spending Arrangement (also Health Flexible Spending Account) puts pre-tax dollars to your personal fund to be used for medical expenses. See also FSA, Flexible Spending Arrangement.
HHS Health and Human Services. See DHHS, U.S. Department of Health and Human Services.
HIPPA The Health Insurance Portability & Accountability Act (1996) made two major changes in health insurance/health care law. First, it protected the medical insurance policies of employees (as well as their families) following a job change or loss. Second, it created national standards for that electronic transfer and exchange of health information. HIPPA also sought to eradicate fraud and waste from health insurance health care, and also to promote health savings accounts that allows you to purchase healthcare.
HIT Health Information Technology (also Health IT) signifies the exchange of patient together with other health information through electronic means. Search engine marketing is now increasingly crucial as medical insurance companies and health care providers have turned into technology in order to reduce costs and improve outcomes-while concurrently aiming to stay in compliance with HIPAA privacy requirements.
HMO A Health Maintenance Organization is a medical care insurance plan that restricts well being services to doctors as well as other providers who are employed or contracted because of the HMO. Generally, out-of-network care is just available on a critical basis.
HMOA The Health Maintenance Organization Act (1973) is often a federal law that required companies with no less than 25 workers to give a federally certified HMO option as well as traditional healthcare plans. It absolutely was amended several times, most recently by in 1996 because of the Medical health insurance Portability and Accountability Act (HIPAA).
HRA A Health Reimbursement Arrangement (also Health Reimbursement Account) allows a boss to play a role in an employee’s personal account so as to provide reimbursement for eligible medical expenses. Unlike similar plans, an HRA is funded because of the employer without by salary deductions.
IRC The Internal Revenue Code (1986) may be the part of federal law that governs the gathering of income, payroll, estate, gift and excise taxes.
IRS The Internal Revenue Service was established in 1862, though the agency’s current name goes back to 1918. It will be the bureau with the U.S. Department within the Treasury (DOT) responsible for collecting taxes and administering the Internal Revenue Code (IRC).
JGTRRA The Jobs and Growth Tax Relief Reconciliation Act (2003) became a package of tax cuts that lowered individual tax rates and also rates on capital gains, dividends and estates. Undoubtedly one of the “Bush tax cuts,” the goal of the legislation would be to counter the post-9/11 recession. However the cuts were originally set to expire, they are extended repeatedly.
LTD?Plan A Long-Term Disability Plan (also Long-Term Disability Income Plan) is a term insurance policy that pays one advantage if an employee includes a covered illness or injury that stops that individual from earning earnings.
MHPA The Mental Health Parity Act (1996) mandated that this limits of mental health advantages in a group health plan be on par with limits for medical and surgical benefits. This legislation was enhanced and replaced by the Mental Health Parity and Addiction Equity Act (MHPAEA).
MHPAEA The Mental Health Parity and Addiction Equity Act (2008) built on the Mental Health Parity Act (MHPA) by extending coverage requirements to mental health/substance use disorders. The requirements were substantially expanded while using passage from the Patient Protection and Affordable Care Act (ACA).
MSA A Medical Savings Account (better known as an Archer MSA) was really a tax-deferred piggy bank often offered during a group benefits package designed to enable participants to fund health-related expenses inside a high-deductible medical care insurance plan. MSAs have been replaced by Health Savings Accounts (HSAs), that have been introduced in 2003.
NAIC The National Association of Insurance Commissioners will be the standards and regulatory agency during the U.S. created and governed by the main insurance regulators from U.S. states, territories, and also the District of Columbia.
NHCE A Non-Highly Compensated Employee is a worker who doesn’t fit the definition of a properly Compensated Employee (HCE) with regards to IRS regulation. According to IRS rules, benefits administrators need to be able to persuade regulators that HCEs and NHCEs are treated similarly.
NMHPA The Newborns’ and Mothers’ Health Protection Act (1996) requires medical care insurance plans that offer maternity coverage to pay extra for at the least a 48-hour a hospital stay (96-hours, when it comes to a cesarean section) pursuing the birth of your child.
OCR The Office for Civil Rights is usually an agency within the U.S. Department of Health insurance Human Services (DHHS) arrested for preventing discrimination in heath care treatment and social service programs. (Note that there’s also a business entitiy for Civil Rights while in the U.S. Department of Education.)
OFCCP The Office of Federal Contract Compliance Programs may be a bureau throughout the U.S. Department operate (DOL) that enforces affirmative action and equal employment opportunity provisions of federal law for companies that do business when using the federal government.
OHCA An Organized Health Arrangement allows a number of companies or entities to show Protected Health Information (PHI) about patients in accordance with HIPAA privacy regulations. The most common variety of OHCA includes the sharing of info from the physician and a hospital the location where the physician has medical privileges.
OMB The Office of Management and Budget will be the bureau inside Executive Office of your President from the U.S. answerable for preparing the president’s budget proposals. What’s more, the OMB evaluates other executive branch policies and operations to determine whether they will be in compliance while using the president’s goals and policies.
PDA The Pregnancy Discrimination Act (1978) revealed that discrimination on the basis of pregnancy, childbirth, or related medical conditions is recognized as unlawful sex discrimination under Title VII from the Civil Rights Act (CRA).
PEO A Professional Employer Organization is really a company that provides hours, employee benefits, payroll and workmans compensation services to client businesses while on an outsourced basis.
PHI Protected Health Information is personally identifiable health information and facts are protected by HIPAA security and privacy rules. When PHI information and facts are maintained or transmitted in electronic or another media, it’s at the mercy of HIPAA requirements.
PHSA The Public Health Services Act (1944) assigned the responsibility of preventing communicable diseases inside the U.S. on the Country Public Health Service. What’s more, it gave the costa rica government authority to create quarantines. The PHSA has become amended sometimes, notably by way of the Insurance coverage Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (ACA).
POP A Premium-Only Plan (also known as a Section 125 Premium-Only Plan) is special method of cafeteria plan allowing employees to spend employer-sponsored group health plans as well as individual health insurance coverage plans with employer-subsidized pre-tax dollars.
PPACA See ACA, Affordable Care Act.
PPO A Preferred Provider Organization is a health plan along with a network of medical service providers a lot like an HMO. PPOs often can be more expensive than HMOs, they also normally have fewer restrictions on getting care from non-network providers. Another major difference is the fact that it’s generally possible inside of a PPO to see a professional or some other doctor and not using a referral or authorization from a primary care physician.
PWBA See EBSA, Employee Benefits Security Administration.
QDRO A Qualified Domestic Relations Order (from a court as the judgement, decree or order) establishes a recipient’s instantly to receive benefits such as supporting your children, alimony payments, or marital property rights payable using a retirement plan.
QMCSO A Qualified Medical Your sons or daughters Order is really a requirement (created by a 1993 amendment to the Employee Retirement Income Security Act, ERISA) that employer group health plans extend coverage of health on the children of a parent-employee who’s divorced, separated, or never married when ordered to do so by state authorities.
RARC The Reasonable Accommodation Resource Center is usually an agency in the U.S. Department on the job (DOL) that serves as a clearinghouse for information, technology and also other assist with support accommodations of workers with disabilities.
SAR A Summary Annual Report is usually a document furnished to benefit plan participants that condenses the results within the Form 5500 annual report to your information and benefit of the enrollee.
SBJPA The Small Business Job Protection Act (1996) was enacted when using the goal to present tax relief for small companies, to guard jobs, to generate opportunities, to enhance the take-home pay of workers. The effective result ended up allow smaller businesses to present 401(k) and pension plans for their workers.
SCHIP The State Children’s Medical insurance Program (sometimes referred to as the Children’s Medical health insurance Program) is a medical care program run by the U.S. Department of Health and Human Services (DHHS). Established in 1997, SCHIP is usually a federal-state partnership the same as Medicaid that provides states some leeway in the right way to structure and manage their programs.
SMM A Summary of fabric Modifications is really a document that needs to be provided to a benefits plan participant if a substantial change is made to here is the plan. Distribution from the SMM is mandated by ERISA and monitored by regulators.
SPD A Summary Plan Description may be a document necessary by ERISA that informs a benefits plan participant concerning their rights and benefits beneath the plan. Regulations also require that this SPD delineate the plan’s sponsor, administrator, and various key components.
SSA The U.S. Social Security Administration is really an agency of your governing administration that manages Social Security, a social benefits package including retirement, disability, and survivors’ benefits programs.
TITLE VII TITLE VII on the Civil Rights Act (CRA) prohibits employment discrimination based on race, color, religion, sex and national origin. Many experts have amended several times-notably because of the Civil Rights Act of 1991 and also the Lily Ledbetter Fair Pay Act of 2009-to provide compensatory and punitive damages for intentional violations.
TPA A Third-Party Administrator is an agent or entity that processes claims and performs other administrative services, usually on an employee benefits program such as a health cafeteria plan.
USC The United States Code is ready by way of the Office with the Law Revision Counsel in the U.S. House of Representatives, and has now a consolidation and codification of all U.S. laws, grouped by material.
USERRA The Uniformed Services Employment and Reemployment Rights Act (1994) protects the reemployment rights of U.S. service members when returning from duty inside uniformed services, prohibiting employer discrimination based on military service or obligation.
VEBA A Voluntary Employees’ Beneficiary Association is a specific type of exempt trust fund that functions as a funding vehicle for health and welfare benefits.
WHCRA The Women’s Health insurance Cancer Rights Act (1998) protects for patients who elect breast reconstruction related to a mastectomy, requiring coverage for reconstructive surgery inside a manner determined in consultation while using patient’s doctor(s).

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