Health Glossary

The Affordable Care Act provides a tax credit to help you afford health coverage purchased through the Connect for Health Colorado marketplace. Advance payments of the tax credit can be used right away to lower your monthly premium costs. If you qualify, you may choose how much advance credit payments to apply to your premiums each month, up to a maximum amount. If the amount of advance credit payments you get for the year is less than the tax credit you’re due, you’ll get the difference as a refundable credit when you file your federal income tax return. If your advance payments for the year are more than the amount of your credit, you must repay the excess advance payments with your tax return.

Once you have picked a health plan through Connect for Health Colorado marketplace, you must report certain life changes. This information may change the coverage or saving your qualify for.

You may have heard of the Affordable Care Act — sometimes called Obamacare — a 2010 federal law intended to increase the value spent on health care, create a culture supporting healthy living and wellness and expand access to care. The law accomplishes this through financial assistance and tax credits for individuals and businesses to purchase insurance through the marketplace. Many of the law’s changes took effect in January 2014.

Colorado passed its own set of health care reform laws that established a state-based marketplace called Connect for Health Colorado. Other laws passed in Colorado expanded Health First Colorado (Colorado’s Medicaid program) coverage to more low income Coloradans and aligned state health insurance regulations with new federal laws.

The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan’s coverage documents. In Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus, covered benefits and excluded services are defined in state program rules.

Insurance program jointly funded by state and federal government. Child Health Plan Plus (CHP+) is low cost health and dental insurance for Colorado’s uninsured children and pregnant women. CHP+ is public health insurance for children and pregnant women who earn too much to qualify for Health First Colorado (Colorado’s Medicaid program), but not enough to afford private health insurance. Colorado’s Child Health Plan Plus (CHP+) program is administered by the Department of Health Care Policy and Financing.

Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay co-insurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.

A fixed amount (for example, $15) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.

A Federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or you experience another qualifying event. If you elect COBRA coverage, you pay 100% of the premiums, including the share the employer used to pay, plus a small administrative fee. Get more information about COBRA from the U.S. Department of Labor.

The share of costs covered by your insurance that you pay out of your own pocket. This term generally includes deductibles, co-insurance, and co-payments, or similar charges, but it doesn’t include premiums, balance billing amounts for non-network providers, or the cost of non-covered services.

Cost-sharing in Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) can include premiums, co-payments and enrollment fees. Some individuals who qualify for Health First Colorado or CHP+ may be exempt from cost-sharing.

The amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services. Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) do not have deductibles.

A child or other individual for whom a parent, relative, or other person may claim a personal exemption tax deduction.

Having a disability means you cannot do any substantial gainful activity or major activity to receive pay (or, in the case of a child having marked and severe functional limitations or have an easily recognized and extreme lack of ability to do everyday activities) because you have been medically determined to have a physical or mental impairment that will either result in death or which has lasted or is expected to last for 12 months in a row or more.

The Department of Regulatory Agencies’ Division of Insurance regulates the insurance industry and assists consumers and other stakeholders with insurance issues. For more information go to doi.colorado.gov/health-insurance.

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

Any Indian or Alaska Native tribe, band, nation, pueblo, village or community that the Department of the Interior acknowledges to exist as an Indian tribe.

Health First Colorado (Colorado’s Medicaid program) is public health insurance for low income Coloradans who qualify. The Colorado Department of Health Care Policy and Financing offers an overview of benefits included as part of Health First Colorado coverage.

To see if you qualify and to apply for coverage online go to colorado.gov/PEAK.

A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to qualify for coverage. HMOs often provide integrated care and focus on prevention and wellness.

The Health Insurance Portability and Accountability Act (HIPAA) is a 1996 federal law designed to protect sensitive health care information and reduce the administrative burden of health care for health care providers.

• HIPAA Privacy Forms For Health First Colorado (Colorado’s Medicaid Program) and Related Programs
• Health First Colorado Notice of Privacy Practices
• Connect for Health Colorado Privacy Policy
• PEAK / Colorado.gov Privacy Statement

IEVS is a system that compares the income that an individual reports when they apply for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) with the income employers report to the Colorado Department of Labor and Employment for all of their employees. If there is a big difference between an individual’s self-reported income and the employer-reported income in IEVS, an individual may be asked to provide an explanation of why the numbers are different, and/or to provide proof of their income.

A Federal health insurance program for people who are age 65 or older and certain younger people with disabilities. Go to Medicare.gov for more information.

You can apply for financial assistance to help you buy insurance through Connect for Health Colorado.

For more information about the Connect for Health Colorado open enrollment period visit ConnectforHealthCO.com or contact Connect for Health Colorado at 1-855-752-6749 / TDD 1-855-346-3432.

Outside of open enrollment, you can still shop for insurance if you have a qualifying life event.

Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) do not have open enrollment periods. You can apply at any time.

Your expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs include deductibles, coinsurance, and co-pays for covered services plus all costs for services that aren’t covered.

The most you pay during a policy period (usually a year) before your health insurance or plan begins to pay 100% of the allowed amount. For private insurance this limit never includes your premiums or health care the plan doesn’t cover. Some health insurance plans don’t count your co-payments, deductibles, coinsurance payments, out-of-network payments, or other expenses toward this limit.

The amount that must be paid for your health insurance or plan. You or your employer usually pay it monthly, quarterly or yearly.

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.

A change in your life may mean you can qualify for a Special Enrollment Period to enroll in private health coverage through the Marketplace, Connect for Health Colorado. Examples of qualifying life events are moving to a new state, changes in your income, and changes in your family size (for example, if you marry, divorce or have a baby). Read more about reporting a life change.

Get more information from Connect for Health Colorado at 1-855-752-6749 / TDD 1-855-346-3432.

You can apply for Health First Colorado (Colorado’s Medicaid Program) or Child Health Plan Plus (CHP+) at any time. If you qualify for Health First Colorado, you can enroll right way. If you or someone in your household qualify for CHP+, you may be required to pay an annual enrollment fee before you can enroll. You can learn more about whether you will need to pay a CHP+ enrollment fee by clicking on the “Payment” tab in your Colorado.gov/PEAK account. You will also get a letter in the mail about the annual enrollment fee for CHP+. You can pay your annual enrollment fee online through your PEAK account or by downloading the free Health First Colorado mobile app from the iTunes and Google Play stores.

A Regional Organization connects Health First Colorado (Colorado’s Medicaid Program) members to providers and also helps members find community and social services in their area. The Regional Organization helps providers communicate with Health First Colorado members and with each other, so Health First Colorado members receive coordinated care. A Regional Organization will also help Health First Colorado members get the right care when they are returning home from the hospital or a nursing facility by providing the support needed for a quick recovery. Regional Organizations help with other care transitions, too, like moving from children’s health services to adult health services, or moving from a hospital to nursing care.

Get more information about Health First Colorado Regional Organizations.

The retroactive cancellation of a health insurance policy. Insurance companies will sometimes retroactively cancel your entire policy if you made a mistake on your initial application when you buy an individual market insurance policy. Under the Affordable Care Act, rescission is illegal except in cases of fraud or intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage.

A health care program for active-duty and retired uniformed services members and their families. See TRICARE.mil for more information.