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Healthcare Glossary

Actual cost: the cost that occurs during a fiscal year.

Actuals: Dollars actually spent on health care that year compared to cost estimates.

Affordable Care Act (ACA): The Patient Protection and Affordable Care Act (PPACA) also known as the Affordable Care Act or ACA  is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010.

The legislation includes a long list of health-related provisions that began taking effect in 2010. Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs and improve system efficiency, and to eliminate industry practices that include revoking and the denial of coverage due to pre-existing conditions.Source

Chief Human Resources Officer (CHRO): The Chief Human Resource decides on policies created by the Joint Health Care Committee. The CHRO has 20 days to approve or deny a motion. 

Comparative Effectiveness Research:Scientific studies that would assess the effectiveness of various medical treatments, medications, and devices. A component of health reform, the research aims to improve quality of care and control costs. (http://www.webmd.com/a-to-z-guides/health-care-reform-glossary#comparative)

Dependent: a covered person who relies on another person for support or obtains health coverage through a spouse, parent or grandparent who is the covered person under a plan.

For a more detailed definition of dependent for the university employee, please refer to the current UA Benefit Handbook, page 15.

Fiscal year: The fiscal calendar year begins on July 1 through June 30 every year.

Flexible Spending Account (FSA): Accounts offered and administered by employers that provide a way for employees to set aside, out of their paycheck, pretax dollars to pay for the employee’s share of insurance premiums or medical expenses not covered by the employer’s health plan.   The employer may also make contributions to a FSA.   Typically, benefits or cash must be used within the given benefit year or the employee loses the money.   Flexible spending accounts can also be provided to cover childcare expenses, but those accounts must be established separately from medical FSAs.

Grandfathered Status/Plans: Health plans in existence with one or more enrollees on March 23, 2010. In order to maintain grandfathered status, plans can only make limited changes to benefits, cost-sharing and other provisions of the plan that were in effect on March 23, 2010 (date of enactment of the health care reform law). Source

Health Savings Account (HSA): A tax-exempt savings account that can be used to pay for current or future qualified medical expenses. Employers may make HSAs available to their employees or individuals can obtain HSAs from most financial institutions. In order to open an HSA, an individual must have health coverage under an HSA-qualified high deductible health plan.

High deductible health plans (HDHP): Health insurance plans that have higher deductibles (the amount of health care costs that must be paid for by the consumer before the insurance plan begins to pay for services), but lower premiums than traditional plans. Qualified high-deductible plans that may be combined with a health savings account must have a deductible of at least $1,150 for single coverage and $2,300 for family coverage in 2009.

High Risk Factors : High-risk factors are health risks, like stress, that increase health care costs.  

High Wage Earners: This new tax applies to earners that make over $200,00 in annual salary or a joint salary over $250,000 annually

Joint Healthcare Committee ( JHHCC for the University of Alaska): The Joint Health Care Committee works with Unions and Management to explore an understanding of the University health plan and employee health issues. It makes informed recommendations to the Unions and Management that contribute to improving the quality, efficiency and cost effectiveness of the health plan and to improving the lives of University employees and all plan participants.

Over Recovery: An over recovery takes place when a business spends less for health care than was initially estimated

Lifetime benefit maximum: A cap on the amount of money insurers will pay toward the cost of health care services over the lifetime of the insurance policy.

Pre-existing condition: Medical conditions that exist before a person seeks out a new health insurance policy. Some insurance companies reject applicants for insurance or limit their coverage if they have pre-existing conditions.

Pre-existing condition exclusions: An illness or medical condition for which a person received a diagnosis or treatment within a specified period of time prior to becoming insured. Health care providers can exclude benefits for a defined period of time for the treatment of medical conditions that they determine to have existed within a specific period prior to the beginning of coverage. Source

  • Projected cost: the estimate of cost for health care during a fiscal year.

Summary of Benefits coverage (SBC): a document that helps insurance consumers compare various health plans and understand the coverage that is offered by an employer.

Under recovery: the amount paid by employees is less than costs needed to be covered.

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