The Affordable Care Act (ACA) is the comprehensive federal health care reform law enacted by the U.S. Congress in 2010. It is also sometimes referred to by its full name, the Patient Protection and Affordable Care Act (PPACA), or –...

A required number of deductibles that must be met by insured family members before the family deductible is met. For example, an insurance company offers a $250 deductible and a two times aggregate deductible. Under this coverage, the family must...

The Allowed Amount is the maximum amount on which payment is based for covered health care services. This may also be called “eligible expense” or “payment allowance” or “negotiated rate” or “allowable amount.” If your provider charges more than your...

An Ambulatory Center is a free-standing entity that furnishes health care services. It is neither integrated with nor a department in a hospital. It provides medical center on an outpatient basis. Physically separate facilities on the campus of a hospital...

An Appeal is a request from you for your health insurer or administrator to review a decision that denies a benefit or payment (or pays a lower-than-expected amount toward the billed charge for a medical service or treatment).  An Appeal...

According to Census data and other studies, more than half of Americans get their health insurance through their employer. And health insurance is among the top benefits that employees look for when considering a job move. More than one-third of...

Balance Billing occurs when a provider sends you a bill for the difference between a provider’s charge for a covered service or treatment and the insurance company’s Allowed Amount. For example, if the provider’s charge is $100.00 and the allowed...

Coinsurance is your share of the costs for covered health care services. It is calculated as a percentage (for example, 20%) of the allowable amount for the service. You pay the coinsurance amount plus your plan deductible (if not already...

Your co-payment is a fixed dollar amount (for example, $30) that you must pay for a covered health care service when you visit a provider.  This amount is usually due at the time the service is provided – not billed...

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) is a federal law passed by Congress that, among other things, allows individuals to maintain health coverage following termination due to a qualifying event. The law applies both to insured employees...