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Benefits: These are health services that are paid for by a health insurance provider.
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COBRA: This is a law that allows people who have health insurance through their jobs keep their insurance for 18 months or more after they leave their jobs. The full name of this law is the Consolidated Omnibus Budget Reconciliation Act.
Certificate of Creditable Coverage: This is a letter from your health plan that says how long you have been covered and helps to prove that you have had at least 18 months of coverage. You need this letter if you want to apply for a HIPAA conversion plan for insurance after you leave your job.
Co-Payment or Co-Pay: Some health plans will not pay all of your health care bills. In those cases, you will have to pay a co-payment to your doctor or pharmacist. This is a small amount, usually $10 to $25. Sometimes, co-payments are more for prescription drugs.
Covered or Coverage: Expenses are "covered" if a health plan will pay for them. If an expense is not "covered," you have to pay it. Your health plan must tell you if an expense is covered or not. Ask if you are not sure.
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DC Healthcare Alliance: This is a group of doctors, hospitals and clinics. You can get low-cost or free health services from them. You have to make less than a certain amount of money each year to be able to join.
DC Healthy Families: DC Healthy Families is a free health insurance program for families with children under age 19 and pregnant women who live in the District. Families must meet certain income requirements to qualify for this program.
Deductible: The amount of money you must pay before your health insurance plan starts to pay for services that are covered.
Diabetes: A disease in which sugar builds up in the blood. People with diabetes can have hear, kidney, and eye problems. Also known as "sugar."
Disability or Disabled: A physical or mental condition that keeps you from doing daily activities on your own. Some examples are: caring for yourself, walking, speaking, breathing, learning, and working.
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Eligible or Eligibility: This means that you are able to get insurance because you meet the qualifications set by the insurance company or other group that runs the insurance program. When you apply for insurance and are accepted, this means that you are "eligible."
Eligible Expense(s): The part of the costs for health care services that an insurance plan will pay for.
Enrollment: This is when a company signs you up for a health insurance program.
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Fair Hearing: This is a meeting to talk about a problem with your health insurance. If you were denied coverage and you think that was wrong, you could ask for a fair hearing to discuss it.
Formulary: This is a list of drugs your health plan will pay for. You will have to pay more for drugs that are not on your health plan's formulary.
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Group Health Plan or Group Insurance: This is a health plan you get through your job, a union, or other organization.
Gynecologist: See "OB/GYN."
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HIPAA: This law says that anyone who has insurance through their job, union, or other organization is allowed to buy health insurance within a certain period of time after they lose their health insurance coverage. This is most important for people who have serious, ongoing health problems who are afraid they will not be able to buy new health insurance because they are in poor health. This law also protects the privacy of your personal health information. The full name of this law is the Health Insurance Portability and Accountability Act of 1996.
HIPAA Conversion Plan: This is a health plan for unemployed people who had health insurance through their jobs. The law lets you buy a HIPAA conversion plan if you have had health insurance for the last 18 months without a gap of more than 63 days. It is called a conversion plan because you are converting, or changing, from a group insurance plan to an individual insurance plan.
HIV/AIDS: HIV stands for "human immunodeficiency virus." This is a virus that kills the cells in your body that fight off disease. AIDS stands for "acquired immunodeficiency syndrome." This is the disease you get when HIV has completely destroyed these cells. Some people call HIV/AIDS "infection."
Health Insurance: Health insurance helps you pay for doctor bills and drug costs. If you have health insurance, you might be able to see a doctor free. Or you might pay as little as $10 or $20. If you live in Washington, DC you can get free or low-cost health insurance if you meet certain requirements.
Health Maintenance Organizations (HMOs): See "health plan."
Health Plan: A health plan allows you access to certain services and doctors free or for a reduced cost. You can sign up to become a member of a health plan. Health plans are sometimes called "Managed Care Plans" or "Health Maintenance Organizations (HMOs)".
High Blood Pressure: Blood pressure is a measurement of the force of the blood pushing against the walls of your arteries. If the pressure of blood going through your arteries and other blood vessels gets too high, it can cause headaches, dizziness, and even lead to a stroke, heart attack, or kidney disease. Also known as "pressure."
Home Health Care: This is healthcare you get by nurses, health aides, or other healthcare workers in your home. An example is physical therapy that helps you get better after an injury. It also means health equipment and supplies you use at home like wheelchairs, hospital beds, and walkers.
Hospice: This is a special way of caring for people who are dying from an illness like cancer.
Household Income: This is the all of money that people in your home make in one year.
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Individual Insurance Plan: This is health insurance you purchase for you or your family that is not through an employer, union, or other group. The monthly cost is usually higher for an individual health insurance plan than for a group health insurance plan.
Infection: See "HIV/AIDS."
Inpatient Care: Health care that you get when you in the hospital, nursing home, or other skilled nursing facility.
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Managed Care Plans: See "health plan."
Medicaid: This is health insurance from the government. It's usually free.
Medicare: Medicare is a health insurance program that helps people who are disabled or who are age 65 or older pay for health services. People on Medicare must pay part of the costs for healthcare.
Medication: See "Prescription drugs."
Medigap Plan: This is a health insurance plan that pays for things not covered by Medicare.
Membership Identification Card: This is a card you get from your health plan. You must show this card when you visit the doctor, hospital, or clinic, or when you go to the pharmacy to fill a prescription.
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OB/GYN: This stands for "Obstetrician/Gynecologist." An OB/GYN is a doctor who treats women during pregnancy, labor, and right after childbirth. An OB/GYN also helps women who have health problems like breast cancer or STDs (Sexually Transmitted Disease).
Over-the-counter Drugs: These are drugs that you can buy without a prescription.
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Physical: This is when a doctor does a series of tests on you to see how healthy you are. For some health plans, you will need to get a physical before you can sign up. Also called a check up.
Podiatrist: This is a doctor who helps people with medical problems with their feet.
Pre-existing Condition: A health problem you had before the date that a new insurance policy starts. Some health insurance companies will turn you down because of a pre-existing condition. Or they may refuse to pay for costs for treatments for a pre-existing condition.
Premium: This is a monthly fee you pay to a health plan.
Preventive Services: These are health services that help protect you from getting sick or keep an illness from getting worse. Examples are immunizations (shots), health screenings like mammograms or HIV tests, and check-ups (or physicals).
Prescription Drugs: Your doctor may tell you that you need to take certain medicines. She will then write a note that you can take to a pharmacy, where someone will give you the medicine. These kinds of medicines cannot be purchased without a note from a doctor. This is called a "prescription."
Pressure: See "High Blood Pressure."
Primary Care Physician or Primary Care Provider: This is the doctor who you see most often when you need healthcare. You might need a referral from your primary care physician if you want to see a specialist, like a podiatrist.
Private Insurance: This is insurance that you get from a company like Blue Cross Blue Shield. With private insurance, you pay a monthly fee, or "premium." You may also have to pay part of the costs for medical services and prescriptions.
Provider Directory: This is a list of doctors, clinics, hospitals, and pharmacies that are part of your health plan.
Provider Network: A group of doctors who are part of your health plan. If a doctor is part of your plan's provider network, you can see them free or by paying a co-payment.
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Recertification: You may have to apply every year to stay in your health plan. Or you may have to do it every six months. This is called recertification.
Referral: This is when your doctor sends you to a specialist. See "specialist."
Representative: This is a person who works with a health plan or the government. He or she can help you if you have questions about your health plan or your health care rights. For example, if you want to know what services are covered by your insurance, you can call a representative from your health plan.
Retroactive Coverage: Sometimes you can get paid back for medical care that you already paid. For example: You might have to pay to see a doctor while you are waiting to sign up for a health plan. If so, you might be able to get some money back after you get in the health plan.
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SSI: This stands for "Supplemental Security Income." This is monthly income that the government gives to people who are elderly, disabled or blind.
Skilled Nursing Facility: This term is used for nursing homes and other places for people who are elderly, disabled, or in need of full-time medical care.
Specialist or Specialty Care: This is a doctor who helps people with a certain kind of health problem or a specific part of the body. Some examples are: a podiatrist, a cardiologist, or an OB/GYN.
Sugar: See "Diabetes."
Symptom: This is something that tells you that you might be sick, like a cough that won't go away or a pain in your body.
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TANF: This stands for "Temporary Assistance to Needy Families." You can get money from TANF if you qualify for it.
Third Party Insurance: This is insurance that someone else gets and that you can use too. For example, you might be covered by insurance that your husband or wife gets from his/her job.
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Urgent Care Center: These are health clinics that treat problems that need medical attention but are not emergencies. For example, you might go to an urgent care center for a small cut or a sore throat, but not if you have a broken bone or chest pains. You usually do not need an appointment, and most urgent care centers are open at night and on the weekends.
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WIC: This stands for "Women, Infants and Children." You can get free food if you qualify for it.