Tribal

Glossary
1 TRIBAL GLOSSARY

The material contained in this glossary was compiled based on information from 

healthcare.gov, federal regulations and guidance, with input from our federal 

partners and the CMS Tribal Technical Advisory Group.

ADVANCED PREMIUM TAX CREDIT (APTC) 

A tax credit that can help you afford coverage bought through the Marketplace. 

Sometimes known as APTC, “advance payments of the premium tax credit,” or premium 

tax credit. Unlike tax credits you claim when you file your taxes, these tax credits can be 

used right away to lower your monthly premium costs. If you qualify, you may choose how 

much advance credit payments to apply to your premiums each month, up to a maximum 

amount. If the amount of advance credit payments you get for the year is less than the tax 

credit you’re due, you’ll get the difference as a refundable credit when you file your federal 

income tax return. If your advance payments for the year are more than the amount of 

your credit, you must repay the excess advance payments with your tax return.

Members of federally recognized tribes and shareholders in ANCSA Corporations may use 

the APTC to purchase a qualified health plan at any metal level.

AFFORDABLE CARE ACT (ACA) 

The comprehensive health care reform law enacted in March 2010. The law was enacted 

in two parts: The Patient Protection and Affordable Care Act was signed into law on 

March 23, 2010 and was amended by the Health Care and Education Reconciliation Act 

on March 30, 2010. The name “Affordable Care Act” is used to refer to the final amended 

version of the law. 

The ACA also includes the permanent reauthorization of the Indian Health Care Improvement 

Act, which extends current law and authorizes new programs and services within the Indian 

Health Service. 

The ACA established the Health Insurance Marketplace which includes special protections for 

members of federally recognized tribes and shareholders in ANCSA Corporations (regional or 

village): 

• Special monthly enrollment periods 

• Cost-sharing reductions through Limited and Zero Cost-sharing Plans 

• Can apply for an exemption from the Shared Responsibility Payment 

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TRIBAL GLOSSARY 2

ALASKA NATIVE CLAIMS SETTLEMENT ACT (ANSCA) SHAREHOLDER

 (REGIONAL OR VILLAGE) 

An individual who owns shares in any Alaska Native village corporation, Alaska Native 

urban corporation, or Alaska Native regional corporation as defined in, or established 

pursuant to, the Alaska Native Claims Settlement Act, 43 U.S.C. 1601 et seq. A list 

of ANCSA corporations is available from the State of Alaska Department of Natural 

Resources at: http://dnr.alaska.gov/mlw/trails/17b/corpindex.cfm 

AMERICAN INDIAN/ALASKA NATIVE (AI/AN) 

Below are the definitions of AI/AN for various health care programs: 

ACA/MARKETPLACE 

A member of a federally recognized tribe, or Alaska Native tribe, band, nation, Pueblo, village, 

or community that the Department of the Interior (DOI) acknowledges as an Indian tribe, 

including ANCSA regional and village corporations. There are over 560 federally recognized 

tribes in the U.S. 

You may see the full list of federally recognized tribes and Alaska Native entities by visiting 

the Bureau of Indian Affairs (BIA) Tribal Directory at: http://www.bia.gov/WhoWeAre/BIA/

OIS/TribalGovernmentServices/TribalDirectory/

MEDICAID/CHIP

An American Indian or Alaska Native or other individual who is eligible for health services through 

the Indian Health Service, tribes and tribal organizations, or urban Indian organizations (I/T/U). 

INDIAN HEALTH SERVICE (IHS)

INDIANS 

Individuals of Indian descent belonging to the Indian community served by the local 

facilities and program of the Indian Health Service are eligible for services. An individual 

may be regarded as within the scope of the Indian Health Service program if he or she 

is regarded as an Indian by the community in which he or she lives as seen by such 

factors as tribal membership, enrollment, residence on tax-exempt land, ownership 

of restricted property, active participation in tribal affairs, or other relevant factors in 

keeping with general Bureau of Indian Affairs practices in the jurisdiction. Eligibility 

based on one’s status as a California Indian, Eskimo, Aleut, or other Alaska Native is 

included within this framework.

NON-INDIANS

Additionally, the following non-Indians are eligible for services from the Indian Health 

Service: 

A. A child under the age of 19 who is the natural child, adopted child, stepchild, foster 

child, legal ward, or orphan of an eligible Indian, 
3 TRIBAL GLOSSARY

B. Spouses of an eligible Indian, if the tribe passed a tribal resolution that makes spouses 

eligible to receive services from the Indian Health Service, or 

C. Non-Indian women who are pregnant with the child of an eligible Indian. 

URBAN INDIANS

The Indian Health Service also contracts with urban Indian organizations to provide 

services to urban populations for which special statutory eligibility criteria apply. To be 

eligible for the exemption as an urban Indian, an individual must reside in an urban center 

where an IHS funded urban Indian health program is located and meet one or more of 

the following four criteria: 

A. Be a member of a tribe, band, or other organized group of Indians, including those 

tribes, bands, or groups terminated since 1940 and those recognized now or in the 

future by the state in which they reside, or who is a descendant, in the first or second 

degree, of any such member, 

B. Be an Eskimo or Aleut or other Alaska Native, 

C. Be considered by the Secretary of the Interior to be an Indian for any purpose 

D. Be determined to be an Indian under regulations promulgated by the Secretary 

AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA) 

The American Recovery and Reinvestment Act of 2009 was created to jumpstart the 

economy, create or save millions of jobs, and put a down payment on addressing longneglected challenges so our country can thrive in the 21st century.

Section 5006 of ARRA provides Protections for American Indians and Alaska Natives 

under Medicaid/CHIP: 

• Exempts AI/ANs from Medicaid coinsurance, deductibles and copayments for services if 

they have received services from an I/T/U or through Contract Health Services/Purchased 

and Referred Care. Any AI/AN eligible for I/T/U services or referral is exempt from 

premiums and enrollment fees. Exempts Indian trust income and resources in determining 

eligibility for Medicaid and CHIP. 

• Exempts Indian trust income and resources from Medicaid estate recovery in Medicaid. 

• Allows AI/ANs enrolled in Managed Care to go to I/T/Us, whether in or outside of the 

network, protects payments for I/T/Us when AI/AN in managed care seek services 

there and establishes criteria for Indian Managed Care Entities. 

• Requires States to solicit advice from I/T/Us on Medicaid and CHIP issues that have a 

direct effect on Indian Health Programs. 
TRIBAL GLOSSARY 4

BALANCE BILLING 

When a provider bills you for the difference between the provider’s charge and the allowed 

amount your health plan will pay. For example, if the provider’s charge is $100 and the 

allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider 

may not balance bill you for covered services. 

This is not allowed in Medicaid, CHIP or for a service that has been authorized by CHS/

PRC. 

CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)

Insurance program jointly funded by state and federal government that provides health 

coverage to low-income children and, in some states, pregnant women in families who 

earn too much income to qualify for Medicaid but can’t afford to purchase private health 

insurance coverage.

Since states have choices in how they design their program, CHIP may have a different 

name in your state. Please visit www.insurekidsnow.gov to find more info on your state’s 

program.

COINSURANCE 

Your share of the costs of a covered health care service, calculated as a percent (for 

example, 20%) of the allowed amount for the service. You pay co-insurance plus any 

deductibles you owe. For example, if the health insurance or plan’s allowed amount for 

an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% 

would be $20. The health insurance or plan pays the rest of the allowed amount. 

• AI/AN enrolled in zero cost sharing plans through the Marketplace may not be 

charged co-insurance when receiving care from an I/T/U or when receiving essential 

health benefits through a QHP. There is no need for a referral from an I/T/U when 

receiving care through a QHP. 

• AI/AN enrolled in limited cost sharing plans through the Marketplace may not be 

charged co-insurance when receiving care from an I/T/U or when receiving essential 

health benefits through a QHP. However, these individuals will need a referral from 

their I/T/U to avoid paying co-insurance. 

• AI/AN who are eligible to receive services from an I/T/U are exempt from co-insurance in 

Medicaid and CHIP. 
5 TRIBAL GLOSSARY

CONTRACT HEALTH SERVICES OR PURCHASED/ REFERRED

CARE (CHS OR PRC) 

Contract Health Services (CHS) means “any health service that is, (A) delivered based on a 

referral by, or at the expense of an Indian health program, IHS, a Tribe or Tribal Organization 

carrying out a CHS program of the IHS under the Indian Self-Determination and Education 

Assistance Act, including for this purpose a referral made by an Urban Indian organization 

(as that term is defined in 25 U.S.C. 1603(h); and, (B) provided by a public or private medical 

provider or hospital that is not a provider or hospital of the Indian health program. The name 

was changed to Purchased/Referred Care (PRC) in 2014. Under the ACA, a person enrolled 

in a limited cost sharing plan through the Marketplace will need to obtain a CHS/PRC 

referral or a referral from an urban Indian organization in order to avoid co-payments and 

deductibles when receiving essential health benefits outside the IHS or Tribal facility. 

COPAYMENT (CO-PAYS) 

A fixed amount (for example, $15) you pay for a covered health care service, usually when you 

get the service. The amount can vary by the type of covered health care service. 

• AI/AN enrolled in zero cost sharing plans through the Marketplace may not be 

charged co-payments when receiving care from an I/T/U or when receiving essential 

health benefits through a QHP. There is no need for a referral from an I/T/U when 

receiving care through a QHP. 

• AI/AN enrolled in limited cost sharing plans through the Marketplace may not be 

charged co-payments when receiving care from an I/T/U or when receiving essential 

health care benefits through a QHP. However, these individuals will need a referral 

from their I/T/U to avoid paying co-payments. 

• AI/AN who are eligible to receive services from an I/T/U are exempt from co-payments 

in Medicaid and CHIP. 

COST SHARING 

The share of costs covered by your insurance that you pay out of your own pocket. This term 

generally includes deductibles, coinsurance, and copayments, or similar charges, but it doesn’t 

include premiums, balance billing amounts for non-network providers, or the cost of non-covered 

services. Cost sharing in Medicaid and CHIP also includes premiums. 

Enrolled members of federally recognized Tribes and ANCSA shareholders who enroll in 

limited or zero cost-sharing plans through the Marketplace are exempt from most costsharing (i.e. deductibles, co-pays and co-insurance) when receiving EHBs. This does not 

include balance billing. 

Under Medicaid and CHIP, AI/AN who have ever used I/T/U or CHS/PRC services are 

exempt from deductibles, coinsurance, copayments and premiums as well as balance 

billing.
TRIBAL GLOSSARY 6

DEDUCTIBLE 

The amount you owe for health care services your health insurance or plan covers before 

your health insurance or plan begins to pay. For example, if your deductible is $1,000, 

your plan won’t pay anything until you’ve met your $1,000 deductible for covered health 

care. The deductible may not apply to all services. 

• AI/AN enrolled in zero cost sharing plans through the Marketplace may not be charged 

deductibles when receiving care from an I/T/U or when receiving essential health 

benefits through a QHP. There is no need for a referral from an I/T/U when receiving 

care through a QHP. 

• AI/AN enrolled in limited cost sharing plans through the Marketplace may not be 

charged deductibles when receiving care from an I/T/U or when receiving essential 

health care benefits through a QHP. However, these individuals will need a referral from 

their I/T/U to avoid paying deductibles. 

• AI/AN who are eligible to receive services from an I/T/U are exempt from deductibles in 

Medicaid and CHIP. 

ESSENTIAL HEALTH BENEFITS (EHB) 

The Affordable Care Act ensures health plans offered in the individual and small 

group markets, both inside and outside of the Health Insurance Marketplace, offer a 

comprehensive package of items and services, known as essential health benefits. 

Insurance policies must cover these benefits in order to be certified and offered in the Health 

Insurance Marketplace. States expanding their Medicaid programs must provide these 

benefits to people newly eligible for Medicaid. 

EHB must include items and services within at least the following 10 categories:

1. Outpatient care you get without being admitted to a hospital (ambulatory patient 

services) 

2. Visits to the emergency room 

3. Hospitalization 

4. Maternity and newborn care 

5. Mental health, behavioral health, and substance abuse treatment 

6. Prescription drugs 

7. Rehabilitative and habilitative services and devices (such as physical, occupational, or 

speech therapies that help improve skills for daily living) 

8. Laboratory services 

9. Preventive and wellness services and chronic disease management (such as 

screenings, check-ups, and monitoring and coordinating treatment) 

10. Pediatric services (including oral and vision care) 

Members of federally recognized Tribes and ANSCA shareholders enrolled in zero or 

limited cost-sharing plans may be charged cost-sharing for non-EHB services provided 

outside of the I/T/U system. Consult your plan documents for more information. 
7 TRIBAL GLOSSARY

EXEMPTION 

Under the Affordable Care Act, most people must pay a fee if they don’t have health 

coverage that qualifies as “minimum essential coverage.” 

You may qualify for an exemption if: 

• You’re uninsured for less than 3 months of the year 

• The lowest-priced coverage available to you would cost more than 8% of your 

household income 

• You don’t have to file a tax return because your income is too low (Learn about the 

filing limit.) 

• You’re a member of a federally recognized tribe or eligible for services through an 

Indian Health Services provider 

• You’re a member of a recognized health care sharing ministry 

• You’re a member of a recognized religious sect with religious objections to insurance, 

including Social Security and Medicare 

• You’re incarcerated (either detained or jailed), and not being held pending disposition 

of charges 

• You’re not lawfully present in the U.S.

FEDERAL POVERY LEVEL (FPL)

A measure of income level issued annually by the Department of Health and Human 

Services. Federal poverty levels are used to determine your eligibility for certain programs 

and benefits. For purposes of the Marketplace, use 2014 FPLs. For Medicaid, use 2015 

FPLs.

2014 income levels for 100% FPL:

• $11,670 for individuals 

• $15,730 for a family of 2 

• $19,790 for a family of 3 

• $23,850 for a family of 4 

2015 income levels for 100% FPL:

• $11,770 for individuals 

• $15,930 for a family of 2 

• $20,090 for a family of 3 

• $24,250 for a family of 4

Federal Poverty Level amounts are higher in Alaska and Hawaii. FPL changes annually. 

For updated information go to: www.aspe.hhs.gov 

FEDERALLY RECOGNIZED TRIBE 

Any Indian or Alaska Native tribe, band, nation, pueblo, village or community that 

the Department of the Interior acknowledges to exist as an Indian tribe. For updated 

information visit: www.bia.gov/WhoWeAre/BIA/OIS/TribalGovernmentServices/

TribalDirectory/

HEALTH INSURANCE MARKETPLACE (ALSO KNOWN AS THE EXCHANGE) 
TRIBAL GLOSSARY 8

A resource where individuals, families, and small businesses can: learn about their 

health coverage options; compare health insurance plans based on costs, benefits, 

and other important features; choose a plan; and enroll in coverage. The Marketplace 

also provides information on programs that help people with low to moderate 

income and resources pay for coverage. This includes ways to save on the monthly 

premiums and out-of-pocket costs of coverage available through the Marketplace, 

and information about other programs, including Medicaid and the Children’s 

Health Insurance Program (CHIP). The Marketplace encourages competition among 

private health plans, and is accessible through websites, call centers, and in-person 

assistance. In some states, the Marketplace is run by the state. In others it is run by 

the federal government. 

HOME AND COMMUNITY BASED SERVICES (HCBS) 

Services and support provided by most state Medicaid programs in your home or community 

that gives help with such daily tasks as bathing or dressing. This care is covered when 

provided by care workers or, if your state permits it, by your family. 

INDIAN HEALTH CARE IMPROVEMENT ACT (IHCIA) 

The Indian Health Care Improvement Act (IHCIA), the cornerstone legal authority for the 

provision of health care to American Indians and Alaska Natives, was made permanent 

when President Obama signed the bill on March 23, 2010, as part of the Patient 

Protection and Affordable Care Act. 

INDIAN INCOME 

Indian income describes a broad range of income derived from tribally related resources, 

including trust income. There are several types of Indian income: 

• Distributions from ANCSA corporations and settlements trusts 

• Per capita payments or distributions from trust or reservation property 

• Income derived from property and rights related to hunting, fishing, and natural 

resources 

• Income from the sale of cultural or subsistence property 

In general, when applying for health insurance on the Marketplace, Medicaid, or CHIP, 

you only report income that is taxable by the IRS. Therefore, most Indian income is not 

counted when determining eligibility for these programs. However, income derived from 

Indian gaming is taxable and is therefore counted when determining eligibility for health 

insurance on the Marketplace, Medicaid, and CHIP.

I/T/U 
9 TRIBAL GLOSSARY

This term includes the Indian Health Service (IHS), a Tribe (or tribal organization) carrying 

out a program of the IHS under the Indian Self-Determination and Education Assistance 

Act, or an urban Indian health organization.

LIMITED COST SHARING 

A limited cost sharing plan is a plan variation available to members of federally recognized 

Tribes and ANCSA shareholders whose income is above 300% of FPL. Individuals enrolled 

in this plan: 

• Don’t pay co-pays, deductibles, or coinsurance when receiving care through an I/T/U 

• Do need a referral from an I/T/U when receiving EHBs through a QHP to avoid paying 

co-pays, deductibles, or co-insurance 

• Can enroll at any metal level on the Marketplace, a bronze plan may be the best 

choice as it costs the least 

LONG TERM CARE 

Services that include medical and non-medical care provided to people who are unable 

to perform basic activities of daily living such as dressing or bathing. Long-term supports 

and services can be provided at home, in the community, in assisted living or in nursing 

homes. Individuals may need long-term supports and services at any age. Medicare and 

most health insurance plans don’t pay for long-term care. 

MEDICAID 

A state-administered health insurance program for low-income families and children, 

pregnant women, the elderly, people with disabilities, and in some states, other adults. The 

federal government provides a portion of the funding for Medicaid and sets guidelines for 

the program. States also have choices in how they design their program, so Medicaid varies 

state by state and may have a different name in your state. Visit www.medicaid.gov to find 

your state’s program. 

MEDICARE 

A federal health insurance program for people who are age 65 or older and certain 

younger people with disabilities. It also covers people with end-stage renal disease 

(permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). 

Different parts of Medicare help cover specific services if you meet certain conditions. 

Under the ACA, elders who have at least Medicare Part A have met the requirement for 

minimum essential coverage. 

METAL LEVELS 
TRIBAL GLOSSARY 10

There are four categories or “metal levels” of coverage in the Marketplace. Plans in each 

category pay different amounts of the total costs of an average person’s care. This takes 

into account the plan’s monthly premiums, deductibles, copayments, coinsurance, and 

out-of-pocket maximums. The actual percentage you’ll pay in total or per service will 

depend on the services you use during the year. 

BRONZE: Your health plan pays 60% on average. You pay about 40%. 

SILVER: Your health plan pays 70% on average. You pay about 30%. 

GOLD: Your health plan pays 80% on average. You pay about 20%. 

PLATINUM: Your health plans pays 90%. You pay about 10%.

All metallic plans offered on the Marketplace provide the same essential health benefits. The only 

difference between plans are plan networks, the cost of premiums and the level of cost-sharing. 

Limited and zero cost sharing plan variations are available at each metallic level for AI/AN. 

Note: If members of federally recognized tribes and shareholders in ANCSA corporations are 

enrolled in a zero or limited cost sharing plan, they are exempt from most cost sharing. A 

bronze level plan provides the same level of coverage at the lowest cost.

MINIMUM ESSENTIAL COVERAGE (MEC) 

The type of coverage an individual needs to have to meet the individual responsibility 

requirement under the Affordable Care Act. This includes: 

• Individual market policies

• Job-based coverage 

• Medicare 

• Medicaid and CHIP 

• Certain VA coverage: Veterans Health Care Program 

TRICARE 

CHAMPVA 

Spina Bifida Health Care Benefits Program 

• Certain other coverage 

Note: IHS is not considered MEC. Individuals who receive care from an I/T/U and do not 

have additional coverage should apply for an exemption from the shared responsibility 

payment in order to avoid a tax penalty. 

MODIFIED ADJUSTED GROSS INCOME (MAGI) 
11 TRIBAL GLOSSARY

The figure used to determine eligibility for lower costs in the Marketplace and for Medicaid 

and CHIP. Generally, MAGI is your adjusted gross income plus any tax-exempt Social 

Security, interest, or foreign income you have. 

Monies derived from protected Indian trust income and resources are deducted from the 

MAGI for Medicaid and CHIP. 

NETWORK 

The facilities, providers and suppliers your health insurer or plan has contracted with to 

provide health care services. 

Your I/T/U provider does not need to be in-network in order for you to continue receiving 

services there without cost sharing. You should tell your I/T/U clinic if you have insurance 

because your clinic can help coordinate your care and make referrals to medical specialists. 

They can make sure your bills get paid when you have insurance and help you with the 

paperwork of insurance and explain what everything means. 

OPEN ENROLLMENT PERIOD 

The period of time during which individuals who are eligible to enroll in a QHP can enroll 

in a plan in the Marketplace. For coverage starting in 2015, the Open Enrollment Period is 

November 15, 2014–February 15, 2015. Individuals may also qualify for Special Enrollment 

Periods outside of Open Enrollment if they experience certain events. You can apply for 

Medicaid or CHIP, at any time of the year. 

Members of federally recognized tribes and ANCSA shareholders may enroll in, change, or 

cancel a Marketplace plan once every month and are not limited to open enrollment periods. 

OUT OF NETWORK 

A provider who does not have a contract with your health insurer or plan to provide 

services to you. You will pay more to use them. Even if your I/T/U provider is out-ofnetwork, you can continue to receive services without additional costs.

OUT OF POCKET COSTS 
TRIBAL GLOSSARY 12

Your expenses for medical care that aren’t reimbursed by insurance. Out-of-pocket costs 

include: 

• Deductibles 

• Coinsurance 

• Copayments 

• Plus all costs for services that aren’t covered 

The maximum out-of-pocket cost limit for any individual Marketplace plan for 2014 can be 

no more than $6,350 for an individual plan and $12,700 for a family plan. 

PER CAPITA 

Generally refers to payments made per person to tribal members from tribal income, 

including payments or distributions from: 

• Certain settlements 

• Tribal trust income derived from tribal land 

• Other tribal revenues that are distributed to tribal members on a per person basis 

• Payment made from gaming revenue, which is taxable income 

For more information about per capita payments as Indian income, see “Indian Income” in 

this glossary. 

PRE-EXISTING CONDITION 

A health problem you had before the date that new health coverage starts. Health 

insurance companies cannot refuse to cover you or charge you more just because you 

have a pre-existing condition. They also can’t charge women more than men. 

PREMIUM 

The amount that must be paid for your health insurance or plan. You or your employer 

usually pays it monthly, quarterly, or yearly. 

Note: While zero and limited cost sharing plans that are available to members of federally 

recognized tribes and shareholders to ANCSA corporations (regional or village) exempt 

plan holders from cost sharing in most circumstances this does not include premiums. 

Premiums for these plans must be paid regularly in order to continue receiving coverage. 

PREVENTIVE SERVICES 
13 TRIBAL GLOSSARY

Routine health care that includes screenings, check-ups, and patient counseling to 

prevent illnesses, disease, or other health problems. Many preventive services are 

considered EHBs under the ACA. For a list of covered preventative services, please visit: 

https://www.healthcare.gov/what-are-my-preventive-care-benefits/ 

PRIMARY CARE PROVIDER 

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse 

practitioner, clinical nurse specialist or physician assistant, as allowed under state law, 

who provides, coordinates or helps a patient access a range of health care services. 

Some insurance companies require that patients identify a primary care provider. You may 

designate your I/T/U provider as your primary care provider.

QUALIFIED HEALTH PLAN (QHP) 

Under the Affordable Care Act, starting in 2014, an insurance plan that is: 

• Certified by the Health Insurance Marketplace 

• Provides essential health benefits 

• Follows established limits on cost sharing (like deductibles, copayments, and out-ofpocket maximum amounts) 

• Meets other requirements

SHARED RESPONSIBILITY PAYMENT (FEE) 

Starting January 1, 2014, if someone doesn’t have a health plan that qualifies as minimum 

essential coverage, he or she may have to pay a fee. This payment will either be a flat fee 

or a percentage of taxable household income, depending on which amount is higher. The 

fee will be: 

• 2014: $95 per adult, $285 for a family or 1% of taxable income 

• 2015: $325 per adult, $975 for a family or 2% of taxable income 

• 2016: $695 per adult, $2085 for a family or 2.5% of taxable income 

The fee for children is half the adult amount. The fee is paid on the 2014 federal income 

tax form, which is completed in 2015. People with very low incomes and others may be 

eligible for waivers. 

Members of federally recognized tribes and ANCSA shareholders and individuals who 

are otherwise eligible for I/T/U services may apply for an exemption from this fee thru the 

marketplace or they may apply for the exemption when filing their 2014 income tax. 

SPECIAL ENROLLMENT PERIOD 
TRIBAL GLOSSARY 14

A time outside of the open enrollment period during which you and your family have a right 

to sign up for health coverage. In the Marketplace, you qualify for a special enrollment 

period 60 days following certain life events that involve a change in family status (for 

example, marriage or birth of a child) or loss of other health coverage. Job-based plans 

must provide a special enrollment period of 30 days. 

Important: Members of federally recognized tribes and shareholders in ANCSA 

Corporations can enroll in Marketplace coverage any time of year. There is no limited 

enrollment period and you can change plans as often as once a month. 

SPECIALIST 

A specialist focuses on a specific area of health care to diagnose, manage, prevent, or 

treat certain types of symptoms and conditions. Your primary doctor may refer you to a 

specialist. 

ZERO COST SHARING 

A zero cost sharing plan is a QHP variation available to members of federally recognized 

tribes and ANCSA shareholders whose income is at or below 300% of FPL. Individuals 

enrolled in this plan: 

• May not have to pay co-pays, deductibles, or coinsurance when receiving care from 

an I/T/U or when receiving EHBs through a QHP 

• Don’t need a referral from an I/T/U when receiving EHBs through a QHP 

• Can enroll at any metal level on the Marketplace, a bronze plan may be the best 

choice as it costs the least
2 TRIBAL GLOSSARY

CMS Tribal Affairs

http://go.cms.gov/AIAN

www.healthcare.gov/tribal

CMS Product No. 11900-N