Each month AssuredPartners NL will discuss a different aspect of the Affordable Care Act. Stay tuned for more updates on the second Thursday of each month. Click here for more Affordable Care Act blogs.
The Affordable Care Act has brought about sweeping changes to the health care industry, and in turn, how organizations handle the administration of their employee benefits and insurance. Reading about the Affordable Care Act might instead leave you scratching your head—use this guide to help decode some of the confusing acronyms you may come across:
• CHIP (The Children’s Health Insurance Program): This program provides health insurance to low-income children who do not qualify for Medicaid, but are unable to afford private health insurance. In some states, this may cover pregnant women also.
• EBSA (Employee Benefits Security Administration): This is a division of the Department of Labor responsible for compliance assistance concerning benefit plans.
• EPO Plan (Exclusive Provider Organization Plan): A managed care plan that only covers services in the plan’s network of doctors, specialists or hospitals (except in emergencies).
• ERRP (Early Retiree Reinsurance Program): Created under health care reform to provide coverage to early retirees.
• FLSA (Federal Fair Labor Standards Act): Amended by PPACA to incorporate health care reform-specific revisions.
• HCERA (Health Care and Education Reconciliation Act): Enacted on March 30, 2010 to amend and supplement PPACA.
• IRO (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.
• PCE (Pre-existing Condition Exclusion): A plan provision imposing an exclusion of benefits due to a pre-existing condition.
• PCIP (Pre-Existing Condition Insurance Plan): A temporary high-risk insurance pool to provide coverage to eligible individuals until 2014.
• PPACA (Patient Protection and Affordable Care Act): The primary health care reform law enacted on March 23, 2010.
• QHP (Qualified Health Plan): A certified health plan that provides an essential health benefits package. A QHP is offered by a licensed health insurer.
• SHOP Exchange (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.
Are you able to keep all these acronyms straight? Check back on the second Thursday of each month as we discuss the Affordable Care Act and what it means to you. For questions about the Affordable Care Act, contact a AssuredPartners NL representative.
This post is not intended to be exhaustive, nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.
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