Glossary of Terms

Term

Secondary Insurance

Secondary insurance applies to people who have two insurance plans. One plan is the primary and the other is secondary. A secondary insurance payer only pays if there are costs the primary insurer did not cover. The secondary insurance payer may not pay all of the uncovered costs. Medicare is…

Term

Service Area

A geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it is also generally the area where you can get routine (non-emergency) services. You may lose coverage if you move…

Term

Silver Health Plan

Plans in Washington Healthplanfinder are available in 4 categories – Bronze, Silver, Gold and Platinum. The category you choose impacts how much of the overall costs of services your insurer pays per year. On average, a Bronze plan pays 60% of the costs, a Silver plan pays 70%, a Gold…

Term

Skilled Nursing Care

Services from licensed nurses in your own home or a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home.

Term

Special Enrollment Period

A time outside of the open enrollment period when you and your family have a right to sign up for health coverage. In Washington Healthplanfinder, you qualify for a special enrollment period 60 days following certain life events that involve a change in family status (for example, marriage…

Term

Special Health Care Needs

The health care and related needs of children who have chronic physical, developmental, behavioral, or emotional conditions. These needs exceed the type or amount generally required by children.

Term

Specialist

A physician specialist is a doctor who focuses on a specific area of medicine or group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions. A non-physician specialist is a provider, but not a doctor, who has additional training in a specific area of health…

Term

Specialist Referral Required

Some health plans ask you to get a referral from your primary care doctor before seeing a specialist in order for the plan to consider them qualified medical expenses. If you do not get a referral for these services, the plan will not cover them under the deductible, co-pay, and/or coinsurance.

Term

Subsidized Coverage

Health coverage that can be obtained through financial assistance programs to help people with low- and middle-incomes.

Term

Summary of Benefits and Coverage (SBC)

An easy-to-read summary that lets you compare the costs and coverage of health plans. You can compare plans based on price, benefits, and other features that may be important to you. You will get a Summary of Benefits and Coverage (SBC) when you shop for coverage on your own or…