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ABC's of Health Care Reform

EmblemHealth has simplified health care reform and mapped out what you need to know.

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Information About Our Proposed 2015 Rates

We have prepared a plain-English summary that provides an explanation of the reasons why premium rate changes are being requested for our Large Group HMO plans.

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Glossary

 
H
Health Benefit Administrator
Professional who manages health insurance for employees.
Health Benefit Exchanges

A health insurance marketplace to be implemented in January 2014 where individuals and small groups can shop for health insurance. The exchange will monitor the insurers that are allowed to sell policies and set the minimum benefits those insurers must provide. Learn more about Health Benefit Exchanges.

Health Benefit Plan

Health insurance product offered by a health plan company that is defined by the benefit contract and represents a set of covered services.

Health Insurance Portability and Accountability Act (HIPAA)

A federal act that protects people who change jobs, are self-employed or who have pre-existing medical conditions. HIPAA standardizes an approach to the continuation of healthcare benefits for individuals and members of small group health plans and establishes parity between the benefits extended to these individuals and those benefits offered to employees in large group plans. The act also contains provisions designed to ensure that prospective or current enrollees in a group health plan are not discriminated against based on health status.

Health Maintenance Organization (HMO)

An organization which provides comprehensive healthcare coverage to its members through a network of doctors, hospitals and other healthcare providers.

Health Professional

An individual who: (1) has undergone formal training in a health care field; (2) holds an associate or higher degree in a health care field, or holds a state license or state certificate in a health care field; and (3) has professional experience in providing direct patient care.

Health Reimbursement Account (HRA)

A Health Reimbursement Account may also be called an HRA or a Health Reimbursement Arrangement. HRAs are employer-funded accounts that are often combined with a High Deductible Health Plan or other type of health plan. Employees can use their HRA funds to pay for qualified out-of-pocket health expenses.

Health Savings Account

A Health Savings Account (HSA) is an account you can put money into to save for future medical expenses. HSAs are often described as medical 401(k)s because these savings accounts are owned by the individual worker, roll over from year to year, and move with the worker when he or she switches jobs or retires. What's different is that money in a Health Savings Account carries triple tax benefits. Contributions, earnings and distributions are free from federal (sometimes state) and Social Security taxes when used for qualified medical expenses.

Healthcare Provider

A professionally licensed individual, facility or entity giving health-related care to patients. Physicians, hospitals, skilled nursing facilities, pharmacies, chiropractors, nurses, nurse-midwives, physical therapists, speech pathologist, laboratories, etc. are providers. All network providers are healthcare providers, but not all providers are network providers. See network provider and non-network provider.

Hearing Services

Diagnostic audiological testing that includes a wide variety of qualitative modalities not only to detect hearing loss, but also to define the nature and extent of a given deficit.

High Deductible Health Plan (HDHP)

High Deductible Health Plans (HDHPs) have a higher than normal deductible, most often in exchange for lower premiums. HDHPs are an example of a consumer directed health plan.

HMO

See 'Health Maintenance Organization'.

Home Health Care

Healthcare services rendered to a member in their home in lieu of confinement in a hospital or skilled nursing facility. Care must be under the supervision of a registered professional nurse. This type of care may include physical, occupation or speech therapy, medical supplies and medication prescribed by a doctor.

Home Infusion Therapy

The administration of intravenous drug therapy in the home. Home infusion therapy includes the following services: solutions and pharmaceutical additives; pharmacy compounding and dispensing services; durable medical equipment; ancillary medical supplies; and, nursing services.

Hospice

A facility or service that provides care for the terminally ill patient and who provides support to the family. The care, primarily for pain control and symptom relief, can be provided in the home or in an inpatient setting.

Hospital

Hospital refers to an institution which provides inpatient services under the supervision of a physician, and which meets the following requirements:

  • provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery;
  • has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry;
  • has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff;
  • maintains medical records for all patients;
  • has a requirement that every patient be under the care of a member of the medical staff;
  • provides 24-hour patient services; and
  • has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements.
Hospital Affiliation

The hospital with which the provider is associated.

HSA

See "Health Savings Account".

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