A term used to describe the structure and arrangement of your health plan, such as fee-for-service, health maintenance organization (HMO), point-of-service (POS), exclusive provider organization (EPO), preferred provider organization (PPO).

Actuarial value is the percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, the consumer would be responsible for, on average, 30% of the costs of all covered benefits.

The health care reform law enacted under President Obama in March 2010.  The ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of health care for individuals and the government. It provides a number of mechanisms—including mandate [..]

A request for your health insurer or plan to review a decision to deny payment for health care services that they have initially determined to be not medically necessary, experimental, or, in certain cases, out-of-network.

A prescription drug that received a patent on its chemical entity, formulation, or use and has been approved by the Food and Drug Administration after clinical testing. When patents expire, generic versions of brand name drugs may be offered under a different name and often at lower costs.

A licensed professional who helps businesses and individuals select and purchase a health plan. Those brokers that choose to sell products in the Marketplace are trained and certified by the NY State Department of Health to complete applications on NY State of Health and are receive commission-based compensation. Due to their commission-based compe [..]

Cafeteria plans, also known as Section 125 plans, allow employees to choose between receiving cash (in the form of earnings) and paying for health insurance and other qualified benefits with pre-tax earnings. For example, one type of Section 125 plan, a premium-only-plan (POP), allows employees to pay for health insurance before taxes, which lowers [..]

Catastrophic Health Plan

Individuals that are trained and certified by the NY State Department of Health to conduct community outreach and complete applications in the NY Sate of Health Marketplace. Unlike navigators, they do not receive compensation from the state, but rather directly from the entity in which they are employed, which may lead to a conflict of interest whe [..]

A public health insurance program for children under the age of 19 that covers a wide range of children's health care and dental needs. Based upon family income, children may qualify for free or low-cost health insurance through this program.