Glossary of Terms
A term that refers to the comprehensive set of benefits covered for children up to age 19 in Washington Apple Health.
An immigration status that is considered eligible for health coverage through Washington Healthplanfinder. The rules for eligible immigration status may differ in different insurance programs.
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm.
Ambulance services for an emergency medical condition.
Plans that provide health and/or drug coverage to former employees or members, and, in some cases, their families. These plans are offered to people through their (or a spouse’s) former employer or employee organization. Many of these plans are not legally required to meet all provisions of the Affordable Care…
The Affordable Care Act (ACA) requires certain employers with at least 50 full-time employees (or equivalents) to offer health insurance coverage to their full-time employees (and their dependents) that meets minimum standards set by the Affordable Care Act, or to make a tax payment called the ESRP.
A set of 10 health care services that all plans must cover. Some benefits are free. Some may have co-pays and co-insurance. Doctor visits and hospital stays Trips to the emergency room Care before and after your baby is born Mental health and substance use treatment services Prescription drugs Services…
Health care services that your health insurance plan does not pay for or cover.
A health insurance plan that only covers services if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).
A review of a plan’s decision to deny coverage for, or payment of, a service by an independent third party. If the plan denies an appeal, an external review can be requested. In urgent situations, an external review may be requested even if the internal appeals process is not yet…