Glossary of Terms

Eligible Immigration Status

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.

Emergency Medical Condition

An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid severe harm.

Employer or Union Retiree Plans

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…

Employer Shared Responsibility Payment (ESRP)

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.

Essential Health Benefits

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…

Excluded Services

Health care services that your health insurance plan does not pay for or cover.

External Review

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…