Glossary

Health Benefits Plan

A plan purchased by an individual or provided through an employer that provides payment for health care services. Some plans are limited to particular types of services such as hospitalization or dental care; others provide comprehensive benefits subject to certain exclusions and limitations. The terms of a health benefits plan are described in a plan document, and this document should be reviewed carefully when choosing a health benefits plan.

Health Care Consumerism

Health care consumerism is a movement that encourages individuals to become more involved in and take more responsibility for making smart health care decisions, managing their health benefits dollars and maintaining their overall health status.

Health Care Reform

This is a broad term for major changes happening in the United States health care system now and in the future. A bill called the Patient Protection and Affordable Care Act (PPACA) was passed into law in March 2010. The law aims to expand health care coverage, improve access to care and stabilize or even lessen the cost of health care. PPACA takes effect on the effective date of new plans on or after September 23, 2010 and on existing plans that renew on or after September 23, 2010.

Health Fund

A term applied to both Health Reimbursement Arrangements (HRAs) and Health Savings Accounts (HSAs) to describe a benefits account that can be used to pay for health care expenses.

Health Insurance Portability and Accountability Act (HIPAA)

HIPAA is a federal law enacted in 1996, designed to improve availability, portability and efficiency of health coverage by:

• Limiting exclusions for pre-existing conditions
• Providing credit for prior health coverage
• Allowing transmission of coverage information (i.e., covered family members and coverage period) to a new insurer
• Providing new rights to allow an individual to enroll for health coverage when he or she loses coverage or has 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) rules seek to improve the efficiency of the health care system by standardizing the electronic exchange of health information and protecting the security and privacy of consumer-identifiable health information.

Health Maintenance Organization (HMO)

A form of health benefits plan that provides or arranges for health services required by its members. In a traditional HMO plan non-emergency services must be received from a network of health care providers, although certain HMO plans may offer reduced benefits for care received outside of the network. In most HMO plans, members are required to select a primary care physician (PCP) from the network to provide routine care and make referrals for specialty and hospital services when appropriate.

Health Plan

A health plan that you buy or that is provided by your employer. It pays for health care services. It may be insured by an insurance company or self-insured by your employer. Some plans are limited to certain services, such as hospitalization or dental care. Other plans provide greater coverage, though they may include exclusions and limitations. The terms of a health plan are described in a plan document. Review this document carefully before you choose a health plan.

Health Reimbursement Arrangement (HRA)

This is an employer-paid account for employees and retirees. The funds are generally available to pay for deductible and co-insurance amounts, although some employers allow the funds to be used for any qualified medical expenses. Unused funds in an HRA may be carried over from year to year, according to rules defined by the employer.

Health Risk Assessment

A form or online tool that is filled out by an individual and used to assess the individual's current health status, as well as risk factors for future illness. It is a good idea to take a health risk assessment to understand your current health risks and ways in which you can reduce your risk for the future.

Health Savings Account (HSA)

This savings account allows people to pay current health care costs or save for future expenses. To be eligible, you must be covered by a high-deductible health plan and not be eligible for coverage under any other health plan. Contributions to the HSA can be made by the employer, the employee or both. Contributions are tax deductible and earn interest tax free. You can take the account with you when you leave your employer. Balances accumulate from year to year. You can use HSA funds to pay for qualified medical expenses or you can withdraw cash, but cash withdrawals become taxable and may be subject to a withdrawal penalty.

High Risk Health Insurance Pools

These private, self-funded health insurance plans are organized by state. They serve high-risk people who meet enrollment criteria and do not have access to group insurance. In most states, these pools are independent entities. Their own boards and administrators govern them. In some states they function as part of the state's department of insurance.

High-Deductible Health Plan

A health benefits plan that meets the deductible and other benefit requirements to permit a covered individual to contribute to a Health Savings Account. Benefit requirements for a high-deductible health plan are established by Federal law. For 2007, the required annual deductible was at least $1,100 for individual coverage or $2,200 for family coverage; these minimums are adjusted annually for the cost of living. Premiums for high-deductible health plans are often lower than for other health plans, and the ability to fund a Health Savings Account is an attractive feature for many individuals. Before selecting one of these plans, however, you should check the total benefits and costs against your own experience and anticipated health needs.

HIPAA

See Health Insurance Portability and Accountability Act (HIPAA)

Home Health Care

Skilled nursing or other therapeutic services provided in a home setting. Often home health care is covered as an alternative or follow-up to hospitalization or nursing home care. Check with your health plan on what services may be covered when provided in your home.

Hospice

A facility that provides supportive care at the end of life for individuals with terminal illnesses (such as cancer or AIDS).

Hospital pre-certification or pre-registration

Under some health plans, you need advance authorization before the plan will pay for certain medical services, such as going to the hospital. Check out your plan documents to see if there are any services that require preauthorization and whether you or your doctor needs to file the request.