Affordable Care Act or ACA: Health care reform law enacted in March 2010.
Essential Health Benefits or EHB: A package of health care items and services that must be covered by certain insurance plans starting in 2014. At a minimum, plans must cover the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services, preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
Exchange: a term initially used to describe what is now known as the Health Insurance Marketplace. See below.
Health Insurance Marketplace: A new competitive insurance marketplace where individuals and small businesses can compare prices and purchase health insurance from a range of health insurance plans available at different prices. Consumers can shop online, over the phone, or in person to find the plan that best meets their needs.
Qualified Health Plan or QHP: A plan which is certified to meet certain criteria to be sold through the state’s health insurance marketplace. QHP’s must provide essential health benefits and adhere to rules stated in the ACA regarding limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximums).
Navigator: an entity with existing relationships or that could readily establish relationships, with employers and employees, consumers, or self-employed individuals that qualify to enroll in a qualified health plan. Entities may include trade, industry, and professional associations, community and consumer-focused nonprofit groups, chambers of commerce, unions, and some additional groups. A navigator shall educate the public on the availability of qualified health plans; distribute fair and impartial information concerning enrollment in qualified health plans, discuss the availability of premium tax credits and cost-sharing reductions; and facilitate enrollment in qualified health plans.