Health Insurance

34 Grandfathered Insurance Policies —Health insurance policies that were in place before March 23, 2010 (when the Affordable Care Act was signed into law) are called grandfathered policies. These policies are allowed to offer the coverage they did before the Affordable Care Act. Plans or policies may lose their grandfathered status if they make certain significant changes that reduce benefits or increase costs to consumers. Minimum Essential Coverage —The least amount of coverage you can have so that you do not have to pay a tax penalty. Any insurance policy that covers California’s Essential Health Benefits qualifies as minimum essential coverage. Network —The facilities, providers, labs, hospitals, and pharmacies that your health plan has contracts with to provide health care. Out-of-pocket limit —The most you pay during a year before your health insurance company begins to pay 100% of the allowed amount. This limit does not include your premium, balance-billed charges, or the costs for health care your plan doesn’t cover. Policy —The written contract between an individual or group policyholder and an insurance company. A policy outlines the responsibilities of both parties. Pre-authorization, pre-approval, or prior approval — This is a form from your health plan that says the service your doctor or you requested is approved. Your health plan can require pre-approval for some services before you receive them, except in an emergency.