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Advance Tax Credit: Different from your tax refund, the tax credit is paid directly to insurance companies to help cover and lower the cost of your monthly insurance premiums.
Affordable Care Act: Common name for the health care law, often referred to as “ObamaCare.” It’s full title is the Patient Protection and Affordable Care Act.
Benefit Package: List of services that are covered by an insurance plan
Catastrophic Plans: High-deductible plan on the Marketplace that provides safety-net coverage in case of an accident or serious illness but only available for individuals under 30 years of age and to some low-income individuals who are exempt from paying the fee because tother insurance is considered unaffordable or because they received a hardship exemption.
Co-Pay: Amount person pays at the time of visit.
Cost-Sharing: Another term for deductibles and co-pays. Native Americans who quality for the Native American Cost-Sharing Savings Program will receive special cost-sharing discounts when they enroll in a Bronze or Silver Plan.
Deductible: Amount person must spend on health care each year before insurance begins to pay.
Essential Health Benefits (EHBs): Per the new healthcare law, the following healthcare services must be included in Marketplace Health Insurance plans:
- Ambulatory Patient Services
- Emergency Services
- Hospitalization
- Maternity and newborn care
- Behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services
- Laboratory services
- Preventative and wellness services
- Chronic disease management
- Pediatric oral and vision services
Individual Shared Responsibility Payment: Americans who can afford health insurance but choose not to but it, must pay a fee knows as the individual shared responsibility payment also sometimes called “individual mandate” or “penalty.” Native Americans are exempt from paying the Shared Responsibility Payment but need to file for an Native American Exemption Number.
Marketplace: A website, also referred to as “Exchange.” It is a health care “one-stop shop” that can be used to find out if you are eligible for SoonerCare, find information about available healthy insurance plans, apply for tax credits and enroll in a plan. Visit the marketplace at www.healthcare.gov
Metallic Plans: Four different level plans available on the marketplace including Bronze, Silver, Gold, and Platinum. The lower premium, the higher the deductible (Bronze & Silver Plans). The higher the premium, the lower the deductible (Gold & Platinum Plans). Catastrophic plans are also available.
Minimum Essential Coverage: The type of coverage an individual needs to have to meet the individual requirement under the Affordable Care Act and Absentee Shawnee Tribe Contract Health Service. This includes individual market policies, job-based coverage, Medicare, Medicaid/SoonerCare/CHIP, Tricare, and certain other coverage. Please note: Medicaid state health programs such as SoonerPlan Family Planning and MHSA-Mental Health & Substance Abuse do not meet the criteria for miminum essential coverage.
Native American Exemption: A special provision for Native Americans that allows an exemption from paying the IRS tax penalty, also known as the “Shared Responsibility Payment” or “individual mandate.” A federally-issued Native American Exemption Number will be issued to Native Americans who apply for the exemption to be used annually on their tax return identifying them as Native American and exempt from paying the IRS tax penalty.
PBA/Patient Benefit Advocate: Absentee Shawnee Tribal Health System staff at both Little Axe Health Center and Shawnee Clinic who can provide enrollment information and assistance to help you and your family access benefits. Contact a PBA if you need a Native American Exemption Application or documentation for descendants stating that you receive healthcare services at Absentee Shawnee Tribal Health System.
Premiums: Monthly payments for insurance
SoonerCare: A healthy coverage State Medicaid program jointly funded by the federal government and state of Oklahoma. This program helps pay some or all medical bills for many people who can’t afford it. It is commonly called Medicaid.
Subsidy: The amount federal government pays to an insurance company to lower the cost of premiums for an individual.
© 2014-2018 Absentee Shawnee Tribal Health Authority, Inc. and Li-Si-Wi-Nwi Health, Inc. All rights reserved.
