Financial Terms Glossary

Catastrophic Plan:
In the Health Care Marketplace, plans that will not cover any benefits other than 3 primary care visits per year before you pay off your deductible. Premiums for these plans are low, but out-of-pocket costs (deductibles, co-pays, or coinsurance) are high. This type of health plan is only available to people under 30 years of age or who can’t afford health coverage and have been given a hardship exemption.

Co-pay:
A fixed amount (such as $20) that you contribute towards a covered health care service under your insurance plan. This amount may differ depending on the type of service and is typically paid at the time of receiving care. Also known as a co-payment.

Coinsurance:
Your portion of the expense for a covered health care service, calculated as a percentage (e.g., 10%). In addition to any deductible you owe, you pay coinsurance. For instance, if your plan covers $100 for a specialist visit and you”ve met your deductible, your 10% coinsurance would be $10. Your insurance plan covers the remainder ($90) of the allowed amount.

Deductible:
A set dollar amount that you must pay for health care services covered by your plan before your insurance provider starts covering them. For example, if your deductible is $2,500, your insurance plan won”t cover covered services until you”ve paid this amount.

Family and Medical Leave Act (FMLA):
A U.S. labor law that provides eligible employees with up to 12 weeks of unpaid, job-protected leave per year for certain family and medical reasons, including serious health conditions.

Fertility Preservation:
A procedure to help someone retain their fertility or ability to have children, typically performed before undergoing medical treatments like chemotherapy that could cause infertility. Examples include sperm banking and egg freezing.

Gold Plan:
In the Health Insurance Marketplace, plans that cover an average of 80 percent of the cost of providing essential health benefits. With a Gold plan, you will pay an average of 20 percent of the cost of essential health benefit services.

Hardship Exemption:
Under the Affordable Care Act, most people must pay a fee if they do not have health insurance coverage that counts as “minimum essential coverage.” One exception is if that person proves a “hardship” (for example, a financial issue) that prevents them from becoming insured. In that case, they are not required to pay the fee.

Health Insurance Marketplace/Exchange:
A resource that allows individuals, families, and small businesses to learn about their options for health coverage; compare health insurance plans based on costs, benefits, and other important qualities; choose a plan; and enroll in coverage. The Marketplace/Exchange also offers information on programs that can help people with low to moderate income and resources pay for coverage. It is able to be accessed through websites, call centers, or through in-person help from a navigator.

Insurance Plans:
Health plans in the Marketplace make up 4 categories—Bronze, Silver, Gold, or Platinum—based on the percentage of the average overall cost of providing essential health benefits to members that the plan pays. The plan category you choose affects the total dollar amount you will likely spend for essential health benefits during the year. The percentages the plans will cover, on average, are 60% (Bronze), 70% (Silver), 80% (Gold), and 90% (Platinum). Catastrophic plans will also be available to some consumers.

Long-Term Disability (LTD) Insurance:
A type of disability insurance that offers income protection for a longer period, usually several years or until retirement age, for those who are unable to work due to long-term or permanent disabilities.

Own-Occupation vs. Any-Occupation:
Terms used to define disability in insurance policies. “Own-occupation” refers to the inability to perform the duties of one”s specific occupation, while “any-occupation” refers to the inability to perform any job suitable for one”s education and experience.

Platinum Plan:
In the Health Insurance Marketplace, plans that cover an average of 90 percent of the cost of providing essential health benefits. With a Platinum plan, you will pay an average of 10 percent of the cost of essential health benefit services. Though your out-of-pocket costs are low when you receive health services, you will pay a high monthly premium.

Preauthorization:
A decision made by your health insurer that a specific healthcare service, treatment, or kind of medical equipment is medically necessary to care for you. Also called prior approval, prior authorization, or precertification.

Premium:
The dollar amount that you must pay for your health plan coverage. If you have health insurance through your employer, you and your employer may each pay a part of the premium monthly, quarterly, or yearly.

Preventive Mastectomy:
The removal of one or both breasts by surgery to prevent or reduce the risk of breast cancer forming in those who are at high-risk of getting the disease. Also called prophylactic or risk-reducing mastectomy.

Referral:
A written order from your primary care doctor for you to see a medical specialist or get certain medical services. Many insurance plans may require that you get a referral before you can receive medical care from anyone except your primary care doctor. If you do not get a referral first, often the plan will not pay for the health care services you receive.

Renewability Provisions:
Clauses in a disability insurance policy that outline the terms under which the policy can be renewed, including whether premiums can change and under what conditions the policy can be canceled.

Residual Benefits:
Benefits provided under a disability insurance policy that offer partial compensation to individuals who can return to work but with reduced earnings due to their disability.

Respite Care:
Short-term care provided to a sick or disabled individual in either a care facility or their home, intended to give temporary relief to the caregiver.

Riders and Add-Ons:
Optional features that can be added to a disability insurance policy to enhance coverage, such as COLA riders, residual benefits, and catastrophic disability coverage.

Short-Term Disability (STD) Insurance:
A type of disability insurance that provides benefits for a short duration, typically from a few weeks to one year, to cover income loss due to temporary disabilities.

Silver Plan:
In the Health Insurance Marketplace, plans that cover an average of 70 percent of the cost of providing essential health benefits. With a Silver plan, you will pay an average of 30 percent of the cost of essential health benefit services.

Social Security Disability Insurance (SSDI):
A United States federal program that provides benefits to individuals who have worked and paid into the Social Security system but are now unable to work due to a disability.

Supplemental Security Income (SSI):
A United States federal income supplement program funded by general tax revenues (not Social Security taxes), designed to help aged, blind, and disabled people who have little or no income by providing cash to meet basic needs for food, clothing, and shelter.

Ticket to Work Program:
A United States Social Security program that helps disability beneficiaries return to work while maintaining benefits. It provides access to vocational rehabilitation, training, and job support services.