Glossary of terms

Actuarial value
Affordable Care Act (ACA)
Affordable coverage
Essential health benefits
Individual mandate
Minimum essential coverage
Premium tax credit
Qualified health plan
State exchange
Subsidy

Actuarial value

The average worth of a health plan to a person.

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Affordable Care Act (ACA)

A law passed in March 2010; also called the health care reform law and often referred to as Obamacare. It contains hundreds of provisions, but most importantly, it requires Americans to have health insurance coverage, most employers to provide coverage and changes the structure of insurance plans in terms of what they have to cover.

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Affordable coverage

The amount you pay for health care must meet very specific rules. First, your plan must pay for at least 60 percent of a group of health care services, also known as minimum essential coverage. Second, your premium for single coverage (not the cost to cover your family—that’s important) cannot be more than 9.5 percent of your total household income.

Ardent offers you affordable coverage. However, you might hear that you can get a better deal through the health insurance marketplace. If you decide to explore the marketplace options, use this form to complete your application. Important: Because Ardent offers affordable coverage, you are not eligible for a premium tax credit.

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Essential health benefits

A list of health services that all plans must cover. Essential benefits include (but are not limited to) emergency care, prescription drugs, maternity and newborn care, mental health and substance abuse services, preventive and wellness care and pediatric services including dental and vision care. Our plans help you pay for essential health benefits and other valuable medical services.

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Individual mandate

Part of the Affordable Care Act that requires Americans to have health insurance or pay a new tax. The rule goes into effect January 1, 2014. There are specific rules about what kind of plan you’re required to have, whether or not you can get help paying for your plan and the tax payment for not having one.

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Minimum essential coverage

Your plan must help pay for at least 60 percent of a specific list of health care services, also called essential health benefits. This is also sometimes referred to as minimum essential value. This term is one rule of affordable coverage.

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Premium tax credit

A cash advance to help cover part of the cost of health insurance through a state exchange. An American who does not have affordable coverage through his or her employer and has a total household income below 400 percent of the poverty level is eligible for a premium tax credit. The credit amount is determined by family size, household income and the cost of plans in the individual’s state exchanges. If you are benefits eligible, you have access to affordable coverage through Ardent and therefore you’re not eligible for a premium tax credit. If you’re not eligible for Ardent benefits, you can find coverage through your state exchange.

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Qualified health plan

Each state exchange must review and certify all plans sold in its marketplace. These are referred to as qualified health plans. All plans must cover the minimum essential benefits. Plans may have different features—like the amount of the deductible or the copay, but the overall value of the plan must equal one of the four standard levels of coverage:

Lastly, a qualified health plan must also maintain a network of providers that has enough hospitals, doctors, mental health providers and other health care providers and make sure that all services are "accessible without reasonable delay."

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State exchange

A marketplace where people can shop for and purchase health insurance online. Think of a mall, but where all the stores sell health care. (See more about what state exchange can do.) Behind the scenes, the marketplace is managed by a board that makes decisions about how to run it, including bringing in outside partners who can perform some functions of the marketplace, such as create the online infrastructure or counsel individuals on their insurance options. One member of each board must be a consumer advocate.

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Subsidy

See premium tax credit.

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