Term

Description

Account

Contains application, verification, and eligibility details for individual and members of the household.

APTC

Advanced Premium Tax Credit - A federal subsidy applied to an Individual/Family’s monthly health insurance premium payment in the form of an advance or refundable federal income tax credit.

Anonymous User

A customer utilizing the functionality of the UHIP without providing any personally identifiable information.

Authentication

System verifies log-in credentials so user can access account.

Carrier, Insurer, Issuer

Each represents the same entity and Carrier/Health Plans/Health Insurer and Issuer terms are used synonymously. This refers to entities other than the patient that finance or reimburse the cost of health services. In most cases, this term refers to insurance carriers, other third-party payers, or health plan sponsors (employers or unions).

Client relationships

Employers and their employees (as employees, not as individuals) will be served by brokers. Individuals and families will be served by navigators. An employee who declines SHOP coverage and accesses the Exchange is doing so as an individual, not an employee.

Co-Payment

A fixed amount paid by the user for a covered health care service.

Deductible

The amount owed for health care services before your health insurance or plan begins to pay.

Dependent Coverage

Insurance coverage for family members of the policyholder, such as spouses, children, or partners.

Designated Employee Administrator

An employer may authorize a “Designated Employee Administrator,” an employee who may perform all tasks and activities on behalf of his/her employer: creating account, initiating/completing/submitting application (including employee roster), plan selection, enrollment, and ongoing account maintenance and management activities.

Exchange Certification

Exchange will certify that an Issuer’s plan(s) meet a defined set of criteria that they can be sold on the Exchange.

Filings

Issuers will not have direct data entry or data edit access to Exchange system.

Health Insurance

A contract that requires a health insurer to pay some or all of a user's health care costs in exchange for a premium.

HUB

In the Hub/Gateway/External Interface terms are used synonymously. This is a place of convergence where data arrives from one or more sources and is forwarded to one or more other sources.

Identity Proofing

Personally Identifiable Information is verified with the Federal Hub to establish a level of trust. Once trust is established an application can be populated with verified data.

Issuer Account

The assumption is that the Issuer will create an account in SERFF and UHIP will create an account profile for the Issuer in the UHIP Exchange.

Issuer Licensing

OHIC will license the Issuer to operate in the state for both on and off Exchange.

Login

User submits user name and password to gain access to account.

Medicaid

Medicaid refers to Rite Care, Rite Share, and CHIP in Phase 1 also known as MAGI Medicaid. Medicaid is a state-administered health insurance program for low-income families and children, pregnant women, the elderly, people with disabilities, and in some states, other adults.

MELG

Medical assistance Eligibility record.

MMIS

Medicaid Management Information System. It is used for Medicaid enrollments and to process Medicaid claims for eligible program recipients.

Navigator

Navigators including assisters, In-Person Assisters, Certified Application Counselors, Call Center Workers and other trusted advisors assist Individuals and Families with understanding their health insurance needs, provide support with coverage decisions, assist with the Exchange website and other programs/services available to the customer, and enroll Individuals and Families into QHPs and Medicaid plans.

Open Enrollment Period

The period of time set up to allow users to choose from available plans, usually once a year.

Premium

The amount that must be paid for a health insurance plan.

Premium Tax Credit

A federal subsidy applied to an Individual/Family’s monthly health insurance premium payment in the form of an advance or refundable federal income tax credit.

Qualified Health Plan Approval

OHIC will provide filing approvals for the QHP and the Exchange will certify the Plan for the Exchange.

Recission

The retroactive cancellation of a health insurance policy. Under the Affordable Care Act, rescission is illegal except in cases of fraud or intentional misrepresentation of facts.

Robohelp

Robohelp is a help authoring tool published by Adobe. It allows delivery of content to different devices in various output formats. For RI UHIP, it includes help in the form of step-by-step user guides directed towards administrative users in WebHelp format.

Robohelp 508-compliance

Section 508 is a part of the Rehabilitation Act of 1973, which requires that electronic and information technology developed, procured, maintained or used by the Federal government or by local and State governments using federal grants be accessible to people with disabilities.

In RoboHelp, the difference between 508-compliance and non 508-compliance is the lack of dynamic HTML used for the Table of Contents, Index, Search and document template.

Special Enrollment Period

A time outside of the open enrollment period during which individuals can sign up for job-based health coverage.

Termination from Medicaid

The voluntary or involuntary closing of Medicaid benefits for a former beneficiary. Termination from Medicaid necessitates Disenrollment from the Medicaid Plan.

Termination/Disenrollment from Qualified Health Plan

The voluntary or involuntary removal of an enrollee from a qualified health plan.

Upload

Compare to copy or transfer data or a program from one's own computer to another computer or server. In the Exchange, users are able to upload documents to support certain tasks.

Term

Description

APTC

Advanced Premium Tax Credit - A federal subsidy applied to an Individual/Family’s monthly health insurance premium payment in the form of an advance or refundable federal income tax credit.

CHIP

Children’s Health Insurance Program. Insurance program jointly funded by state and Federal government that provides health insurance to low-income children and, in some states, pregnant women in families above Medicaid limits but who cannot afford to purchase private health insurance coverage.

CMS

Centers for Medicare & Medicaid Services  - Federal agency that administers the Medicaid and Medicare programs.

COBRA

Consolidated Omnibus Budget Reconciliation Act law that may allow citizens to temporarily keep health coverage after their employment ends, they lose coverage as a dependent of the covered employee, or another qualifying event.

COLA

Cost Of Living Adjustment

CSR

Cost Share Reduction. A Federal subsidy that offers cost sharing relief based on affordability for eligible individuals and families.

DHS

Department of Human Services

DOB

Date of Birth

EIN

Employer’s Identification Number - Also known as the Federal Employer Identification Number (FEIN) or the Federal Tax Identification Number, the EIN is a unique nine-digit number assigned for the purposes of identification by the Internal Revenue Service (IRS) to business entities operating in the United States.

Exchange Certification

Exchange will certify that an Issuer’s plan(s) meet a defined set of criteria that they can be sold on the Exchange.

EOHHS

Executive Office of Health and Human Services

FMLA

Family and Medical Leave Act - A Federal law that guarantees up to 12 weeks of job protected leave for certain employees when they need to take time off due to serious illness or disability, to have or adopt a child, or to care for another family member.

FEIN

Federal Employer Identification Number

FPL

Federal Poverty Level. A measure of income level issued annually by the Department of Health and Human Services used to determine eligibility for certain programs and benefits.

HIPAA

Health Insurance Portability and Accountability Act

HITECH

Health Information Technology for Economic and Clinical Health Act

HIX

Health Insurance Exchange

HUB

In the Hub/Gateway/External Interface terms are used synonymously. This is a place of convergence where data arrives from one or more sources and is forwarded to one or more other sources.

IRS

Internal Revenue Service

IAP

Insurance Affordability Program

LTC

Long Term Care

MA

Medical Assistance

MAGI

Modified Adjusted Gross Income

MEC

Minimum Essential Coverage

MELG

Medical assistance Eligibility record

MMIS

Medicaid Management Information System. It is used to for Medicaid enrollments and process Medicaid claims for eligible program recipients.

PII

Personally Identifiable Information  -  Refers to information which can be used to distinguish or trace an individual’s identity, such as their name, social security number, biometric records, etc., alone, or when combined with other personal or identifying information which is linked or linkable to a specific individual, such as date and place of birth, mother’s maiden name, etc. 

PPACA

Patient Protection and Affordable Care Act. The health care reform law enacted in March 2010.

PTC

Premium Tax Credits

QHP

Qualified Health Plan  - A health insurance plan that meets the requirements to be sold through the Exchange.

SERFF

System for Electronic Rate and Filings: The SERFF system is designed to enable companies to send and states to receive, comment on, and approve or reject insurance industry rate and filings.

SHOP

Small Business Health Options Program. ACA provides for separate Small Business Health Options Program (SHOP) Exchanges from which small businesses with up to 100 employees can obtain coverage for their employees. Prior to 2016, states can limit Exchanges to businesses with 50 or fewer workers, and, beginning in 2017, states can allow businesses with more than 100 employees to purchase coverage from an Exchange.

SSA

Social Security Administration

SSI

Supplemental Security Income. A Federal income supplement program funded by general tax revenues.

SSN

Social Security Number

SSP

State Supplemental Payment for the SSI Program. Term created after state portion of the SSI payments was brought in-house vs. Federal issuance.

UHIP

Unified Health Infrastructure Project is the interagency project intended to develop integrated eligibility and enrollment in health insurance affordability programs, including attendant notices, appeals, customer support, plan management, etc.