Insurance terms

The family glitch is a rule that prevents some families with employer-sponsored health insurance from receiving financial assistance for marketplace coverage. It happens when the employer's coverage is considered "affordable" for the employee, even if it's not affordable for the entire family. This makes marketplace coverage too expensive for many families, leaving them with limited options.

The FPL sets income thresholds used to determine eligibility for various healthcare programs under the Affordable Care Act (ACA). It helps decide who qualifies for subsidies, Medicaid, or CHIP by comparing household income to these set levels. In 2023, 400% above the FPL represents an income of $111K for one person or $228K for a family of four.

The FFM is an online platform the federal government runs where individuals and families can compare, shop for, and enroll in health insurance plans. It serves as a marketplace for different insurance options.

This is a payment model in which healthcare providers charge for each service or treatment they provide.

A fiduciary is a person who holds a legal or ethical relationship of trust with one or more other parties. Fiduciaries are persons or organizations that act on behalf of others and are required to put the clients’ interests ahead of their own.

A final internal adverse benefit determination involves a medical condition where the timeframe for completion of a standard external review would seriously jeopardize the life or health of the claimant or would jeopardize the claimant's ability to regain maximum function, or if the final internal adverse benefit determination concerns an admission, availability of care, continued stay or health care service for which the claimant received emergency services, but has not been discharged from a facility.

An FSA is a savings account you can contribute to from your paycheck before taxes. You can use this money for qualified medical costs like copayments, deductibles, and some over-the-counter items. Notably, FSAs are tax-free.

A drug formulary is a list of drugs approved by a health insurance provider, categorized by cost.

The Free Look Period allows you to review your insurance policy after purchasing it. If you change your mind within this period, you can cancel the policy and get a refund without penalties.

This is a measure employers use to determine whether they're required to offer health insurance under specific laws. It's calculated by adding up all the hours part-time employees work and converting them into the equivalent of full-time employees.