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Health Care Reform: Common Acronyms

posted by on Tuesday, July 21, 2015

There are a growing number of acronyms used in health care reform-related materials today. Here is a list of common acronyms and a definition for each: 

ACA:

The Affordable Care Act. Used to refer to the final, amended version of the health care reform legislation.

CDC:

The Centers for Disease Control and Prevention. 

CHIP:

The Children's Health Insurance Program. Program that provides health insurance to low-income children, and in some states, pregnant women who do not qualify for Medicaid but cannot afford to purchase private health insurance. 

DOL:

United States Department of Labor

EBSA:

Employee Benefits Security Administration. A division of the DOL responsible for compliance assistance regarding benefit plans. 

EPO Plan:

An exclusive provider organization plan. A managed care plan that only covers services in the plan's network of doctors, specialists or hospitals (except in an emergency).

ERRP:

The Early Retiree Reinsurance Program. A temporary program created under health care reform to provide coverage to early retirees.

FPL:

Federal poverty level. A measure of income level issued annually by HHS and used to determine eligibility for certain programs and benefits. 

FLSA: 

The Federal Fair Labor Standards Act. Amended by PPACA to incorporate health care reform-specific provisions.

FSA:

Flexible spending account.  Read our blog article on FSA eligible expenses.

HCERA:

The Health Care and Education Reconciliation Act of 2010. Enacted on March 30, 2010, to amend and supplement PPACA.

HCR:

Health care reform.

HDHP:

High deductible health plan. 

HHS:

United States Department of Health and Human Services. 

HMO:

Health maintenance organization. A type of health insurance plan that typically limits coverage to care from medical providers who work for or contract with the HMO.

HRA:

Health reimbursement arrangement or account.

HSA:

Health savings account.

IRO:

An independent review organization. An organization that performs independent external reviews of adverse benefit determinations. 

MLR:

Medical loss ratio. Refers to the claims costs and amounts expended on health care quality improvement as a percent of total premiums. This ratio excludes taxes, fees, risk adjustments, risk corridors and reinsurance.

NAIC:

The National Association of Insurance Commissioners

OCIIO:

The Office of Consumer Information and Insurance Oversight. A division of HHS responsible for implementing many of the health care reform provisions. 

OOP: 

Out-of-pocket limit. The maximum amount you have to pay for covered services in a plan year. 

PCE: 

Pre-existing condition exclusion. A plan provision imposing an exclusion of benefits due to a pre-existing condition.

PCIP: 

The Pre-existing Condition Insurance Plan. A temporary high-risk insurance pool that provided coverage to eligible individuals until 2014. 

POS Plan: 

Point-of-service plan. A type of plan in which you pay less if you go to doctors, hospitals and other health care providers that belong to the plan's network. POS plans require a referral from your primary care doctor to see a specialist. 

PPACA:

The Patient Protection and Affordable Care Act. Enacted on March 23, 2010, as the primary health care reform law. 

PPO:

Preferred provider organization. A type of health plan that contracts with medical providers (doctors, hospitals) to create a network of participating providers. You pay less when using providers in the plan's network, but can use providersoutside the network for an additional cost. 

QHP: 

Qualified health plan. A certified health plan that provides an essential health benefits package. Offered by a licensed health insurer. 

SHOP Exchange: 

The Small Business Health Options Program. A program that each health insurance exchange must create to assist eligible small employers when enrolling their employees in qualified health plans offered in the small-group market. 

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