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['glossary'] | ['glossary'] | [] | Guaranteed Renewal | Renovación garantizada | /glossary/guaranteed-renewal/ | Un requisito por el cual, su compañía de seguro deberá renovarle la póliza mientras usted continúe pagando las primas. Excepto en algunos estados, una renova... | [] | [] | [] | [] | [] | A requirement that your health insurance issuer must offer to renew your policy as long as you continue to pay premiums. Except in some states, guaranteed re... |
['glossary'] | ['glossary'] | [] | Guaranteed Issue | Emisión garantizada | /glossary/guaranteed-issue/ | Un requisito que plantea que los planes de salud deben permitirle inscribirse independientemente de su estado de salud, edad, sexo u otros factores que pueda... | [] | [] | [] | [] | [] | A requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict the use of health ser... |
['glossary'] | ['glossary'] | [] | Grievance | Queja | /glossary/grievance/ | Una queja que usted comunica a su asegurador o plan médico. | [] | [] | [] | [] | [] | A complaint that you communicate to your health insurer or plan. |
['glossary'] | ['glossary'] | [] | Grandfathered | Planes con “derechos adquiridos” (grandfathered) | /glossary/grandfathered/ | Según la definición usada en la Ley del Cuidado de Salud a Bajo Precio: son los que están exentos de ciertas normas de esta Ley. | [] | [] | [] | [] | [] | As used in connection with the Affordable Care Act: Exempt from certain provisions of this law. |
['glossary'] | ['glossary'] | [] | Grandfathered Health Plan | Plan de “derechos adquiridos” | /glossary/grandfathered-health-plan/ | Una póliza de seguro médico individual comprada en o antes del 23 de marzo de 2010. Estos planes no fueron vendidos a través del Mercado, sino por compañías ... | [] | [] | [] | [] | [] | An individual health insurance policy purchased on or before March 23, 2010. These plans weren’t sold through the Marketplace, but by insurance companies, ag... |
['glossary'] | ['glossary'] | [] | Fully Insured Job-based Plan | Plan de seguro total subsidiado por el empleador | /glossary/fully-insured-job-based-plan/ | Un plan médico de una compañía de seguros comprado por un empleador. | [] | [] | [] | [] | [] | A health plan purchased by an employer from an insurance company. |
['glossary'] | ['glossary'] | [] | Formulary | Formulario - Lista de medicamentos | /glossary/formulary/ | Una lista de medicamentos cubiertos por un plan de medicamentos recetados u otro plan médico que ofrezca beneficios de medicamentos recetados. También conoci... | [] | [] | [] | [] | [] | A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list. |
['glossary'] | ['glossary'] | [] | Flexible Spending Account (FSA) | Cuenta de Gastos Flexible (FSA en inglés) | /glossary/flexible-spending-account-fsa/ | Acuerdo que se lleva a cabo a través de su empleador para pagar varios gastos médicos de su bolsillo en dólares antes de impuestos Los gastos permitidos incl... | [] | [] | [] | [] | [] | An arrangement through your employer that lets you pay for many out-of-pocket medical expenses with tax-free dollars. Allowed expenses include insurance copa... |
['glossary'] | ['glossary'] | [] | Flexible Benefits Plan | Plan de beneficios flexible | /glossary/flexible-benefits-plan/ | Programa de beneficios que ofrece a los empleados elegir entre varios beneficios, incluyendo dinero en efectivo, seguro de vida, seguro médico, vacaciones, p... | [] | [] | [] | [] | [] | A benefit program that offers employees a choice between various benefits including cash, life insurance, health insurance, vacations, retirement plans, and ... |
['glossary'] | ['glossary'] | [] | Federally Qualified Health Center (FQHC) | Centro de Salud Federalmente Calificado (FQHC en inglés) | /glossary/federally-qualified-health-center-fqhc/ | Centros de salud sin fines de lucro financiados por el gobierno federal o clínicas que prestan sus servicios a poblaciones y zonassub-atendidas desde el pun... | [] | [] | [] | [] | [] | Federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. Federally qualified health centers provide prima... |
['glossary'] | ['glossary'] | [] | Federal Poverty Level (FPL) | Índice Federal de Pobreza (FPL en inglés) | /glossary/federal-poverty-level-fpl/ | Una medida del nivel de ingresos emitida anualmente por el Departamento de Salud y Servicios Humanos (HHS en inglés). Los niveles federales de pobreza se uti... | [] | [] | [] | [] | [] | A measure of income issued every year by the Department of Health and Human Services (HHS). Federal poverty levels are used to determine your eligibility for... |
['glossary'] | ['glossary'] | [] | Family and Medical Leave Act (FMLA) | Ley de Licencia Familiar y Médica (FMLA en inglés) | /glossary/family-and-medical-leave-act-fmla/ | Una ley federal que garantiza hasta 12 semanas de licencia de trabajo con protección para determinados empleados cuando necesitan tomarse tiempo libre por un... | [] | [] | [] | [] | [] | A federal law that guarantees up to 12 weeks of job protected leave for certain employees when they need to take time off due to serious illness or disabilit... |
['glossary'] | ['glossary'] | [] | Exclusive Provider Organization (EPO) Plan | Plan de organizaciones de proveedores exclusivos (EPO en inglés) | /glossary/exclusive-provider-organization-epo-plan/ | Un plan de atención administrada en donde los servicios están cubiertos sólo si usted consulta a médicos, especialistas u hospitales dentro de la red del pla... | [] | [] | [] | [] | [] | A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency).Related ... |
['glossary'] | ['glossary'] | [] | Excluded Services | Servicios excluidos | /glossary/excluded-services/ | Servicios médicos que su seguro o plan médico no cubren y no pagan. | [] | [] | [] | [] | [] | Health care services that your health insurance or plan doesn’t pay for or cover. |
['glossary'] | ['glossary'] | [] | Exchange | Intercambio de seguros | /glossary/exchange/ | Este es otro término para el Mercado de Seguros Médicos, un servicio disponible en todos los estados que ayuda a los individuos, las familias y los pequeños ... | [] | [] | [] | [] | [] | Another term for the Health Insurance Marketplace®, a service available in every state that helps individuals, families, and small businesses shop for and en... |
['glossary'] | ['glossary'] | [] | Essential Health Benefits | Beneficios/Beneficios de salud esenciales | /glossary/essential-health-benefits/ | Un conjunto de 10 categorías de servicios que planes de seguro médico deben cubrir para cumplir los requisitos de la Ley de Cuidado de Salud Accesible. Estos... | [] | [] | [] | [] | [] | A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient... |
['glossary'] | ['glossary'] | [] | Employer Shared Responsibility Payment (ESRP) | Pago por responsabilidad compartida del empleador (ESRP en inglés) | /glossary/employer-shared-responsibility-payment/ | La Ley de atención médica requiere que ciertos empleadores con al menos 50 empleados a tiempo completo (o a tiempo competo equivalentes) ofrezcan cobertura d... | [] | [] | [] | [] | [] | The Affordable Care Act requires certain employers with at least 50 full-time employees (or equivalents) to offer health insurance coverage to its full-time ... |
['glossary'] | ['glossary'] | [] | Emergency Services | Servicios de emergencia | /glossary/emergency-services/ | Evaluación de una condición médica de emergencia y del tratamiento adecuado para evitar que esa condición empeore. | [] | [] | [] | [] | [] | Evaluation of an emergency medical condition and treatment to keep the condition from getting worse. |
['glossary'] | ['glossary'] | [] | Emergency Room Care | Cuidados de emergencia | /glossary/emergency-room-care/ | Servicios que recibe en una sala de emergencias. | [] | [] | [] | [] | [] | Emergency services you get in an emergency room. |
['glossary'] | ['glossary'] | [] | Emergency Medical Transportation | Transporte médico de emergencia | /glossary/emergency-medical-transportation/ | Servicios de ambulancia en caso de una condición médica de emergencia. | [] | [] | [] | [] | [] | Ambulance services for an emergency medical condition. |
['glossary'] | ['glossary'] | [] | Emergency Medical Condition | Condición médica de emergencia | /glossary/emergency-medical-condition/ | Una enfermedad, lesión, síntoma o enfermedad tan grave, que cualquier persona razonable buscaría atención de inmediato para evitar un daño grave. | [] | [] | [] | [] | [] | An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm. |
['glossary'] | ['glossary'] | [] | Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT) | Servicios de detección temprana y periódica, diagnóstico, y tratamiento (EPSDT en inglés) | /glossary/early-and-periodic-screening-diagnostic-and-treatment-services-epsdt/ | Término usado para referirse al conjunto de beneficios completos cubiertos para los niños bajo Medicaid. | [] | [] | [] | [] | [] | A term used to refer to the comprehensive set of benefits covered for children in Medicaid. |
['glossary'] | ['glossary'] | [] | Durable Medical Equipment (DME) | Equipo Médico Duradero (DME en inglés) | /glossary/durable-medical-quipment-dme/ | Equipos y suministros prescritos por un proveedor de cuidado médico para uso diario o prolongado. La cobertura de DME puede incluir equipos de oxígeno, silla... | [] | [] | [] | [] | [] | Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches ... |
['glossary'] | ['glossary'] | [] | Donut Hole, Medicare Prescription Drug | Interrupción de la cobertura de las recetas médicas (“Donut hole”). | /glossary/donut-hole-medicare-prescription-drug/ | La mayoría de los planes con cobertura de medicamentos recetados de Medicare (Parte D) tienen una interrupción de cobertura (conocida como "donut hole"). Est... | [] | [] | [] | [] | [] | Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have s... |
['glossary'] | ['glossary'] | [] | Disability | Incapacidad | /glossary/disability/ | Una limitación para realizar las tareas de la vida diaria, como por ejemplo, ver, oír, caminar, razonar o trabajar. Debido a que cada programa puede tener di... | [] | [] | [] | [] | [] | A limit in a range of major life activities. This includes activities like seeing, hearing, walking and tasks like thinking and working. Because different pr... |
['glossary'] | ['glossary'] | [] | Dependent Coverage | Cobertura de dependientes | /glossary/dependent-coverage/ | Cobertura médica para miembros de la familia del beneficiario de la póliza, tales como cónyuge, niños o pareja. | [] | [] | [] | [] | [] | Insurance coverage for family members of the policyholder, such as spouses, children, or partners. |
['glossary'] | ['glossary'] | [] | Creditable Coverage | Cobertura válida | /glossary/creditable-coverage/ | Cobertura de seguro médico en virtud de cualquiera de las siguientes opciones: un plan de salud de grupo; un seguro médico individual; un seguro médico estud... | [] | [] | [] | [] | [] | Health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance; Medicare; Medicaid; CHAMPUS... |
['glossary'] | ['glossary'] | [] | Cost Sharing | Costos compartidos | /glossary/cost-sharing/ | La porción de los costos por servicios cubiertos por su asegurador, que usted paga de su propio bolsillo. Este término generalmente incluye los deducibles, e... | [] | [] | [] | [] | [] | 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 s... |
['glossary'] | ['glossary'] | [] | Conversion | Conversión | /glossary/conversion/ | En algunos estados es la habilidad de cambiar su cobertura de empleador por una póliza individual cuando usted pierde su elegibilidad para una cobertura basa... | [] | [] | [] | [] | [] | The ability, in some states, to switch your job-based coverage to an individual policy when you lose eligibility for job-based coverage. Family members not c... |
['glossary'] | ['glossary'] | [] | Complication of Pregnancy | Complicaciones durante el embarazo | /glossary/complications-of-pregnancy/ | Condiciones que se presentan durante el embarazo, parto y nacimiento que requieren asistencia médica para prevenir un daño grave para la salud de la madre o ... | [] | [] | [] | [] | [] | Conditions due to pregnancy, labor and delivery that require medical care to prevent serious harm to the health of the mother or the fetus. Morning sickness ... |
['glossary'] | ['glossary'] | [] | Competitive Bidding | Oferta competitiva (subasta) | /glossary/competitive-bidding/ | Una subasta abierta para contratos federales entre grupos independientes que compiten por el contrato presentando la mejor oferta. | [] | [] | [] | [] | [] | Open bidding for federal contracts between independent groups that compete for the contract by providing the best bid. |
['glossary'] | ['glossary'] | [] | Community Rating | Calificación comunitaria | /glossary/community-rating/ | Una norma que evita que los aseguradores médicos modifiquen las primas dentro de un área geográfica en base a edad, sexo, estado de salud, u otros factores. | [] | [] | [] | [] | [] | A rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors. |
['glossary'] | ['glossary'] | [] | COBRA | COBRA | /glossary/cobra/ | Una ley federal que le permite mantener temporalmente su cobertura médica después de que termine su empleo, pierda la cobertura como dependiente de un emplea... | [] | [] | [] | [] | [] | A federal law that may allow you to temporarily keep health coverage after your employment ends, you lose coverage as a dependent of the covered employee, or... |
['glossary'] | ['glossary'] | [] | Copayment | Copago | /glossary/co-payment/ | Una cantidad fija ($20, por ejemplo) que paga por un servicio de atención médica cubierto después de haber pagado su deducible.Digamos que el costo permiti... | [] | [] | [] | [] | [] | A fixed amount ($20, for example) you pay for a covered health care service after you've paid your deductible.Let's say your health insurance plan's allowa... |
['glossary'] | ['glossary'] | [] | Coinsurance | Coseguro | /glossary/co-insurance/ | El porcentaje de los costos de un servicio de atención médica cubiertos que usted paga (20%, por ejemplo) después de haber pagado su deducible.Digamos que ... | [] | [] | [] | [] | [] | The percentage of costs of a covered health care service you pay (20%, for example) after you've paid your deductible.Let's say your health insurance plan'... |
['glossary'] | ['glossary'] | [] | Claim | Reclamación | /glossary/claim/ | Una solicitud de pago que usted o su proveedor de servicios de salud envía a su asegurador cuando recibe artículos o servicios que usted considera estar cubi... | [] | [] | [] | [] | [] | A request for payment that you or your health care provider submits to your health insurer when you get items or services you think are covered. |
['glossary'] | ['glossary'] | [] | Chronic Disease Management | Control de enfermedades crónicas | /glossary/chronic-disease-management/ | Un enfoque de atención integrada que permite controlar las enfermedades que requieren controles médicos, exámenes, tratamiento de monitoreo y coordinación y ... | [] | [] | [] | [] | [] | An integrated care approach to managing illness which includes screenings, check-ups, monitoring and coordinating treatment, and patient education. It can im... |
['glossary'] | ['glossary'] | [] | Children's Health Insurance Program (CHIP) | Programa de Seguro Médico para Niños (CHIP) | /glossary/childrens-health-insurance-program-chip/ | Un programa de seguro médico que ofrece cobertura de salud de bajo costo para niños de familias que ganan demasiado dinero para calificar para Medicaid, pero... | [] | [] | [] | [] | [] | Insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy priva... |
['glossary'] | ['glossary'] | [] | Catastrophic Health Plan | Plan Catastrófico | /glossary/catastrophic-health-plan/ | Planes médicos que cumplen todos los requisitos aplicables a otros Planes Médicos Calificados (QHP) pero que no cubren ningún beneficio excepto por 3 visita... | [] | [] | [] | [] | [] | Health plans that meet all of the requirements applicable to other Qualified Health Plans (QHPs) but don't cover any benefits other than 3 primary care visit... |
['glossary'] | ['glossary'] | [] | Care Coordination | Coordinación del cuidado de la salud | /glossary/care-coordination/ | La coordinación de su tratamiento a través de varios proveedores de servicios de salud. Los hogares médicos y las organizaciones responsables de la atención,... | [] | [] | [] | [] | [] | The organization of your treatment across several health care providers. Medical homes and Accountable Care Organizations are two common ways to coordinate c... |
['glossary'] | ['glossary'] | [] | Biosimilar Biological Products | Biosimilares Productos Biológicos | /glossary/biosimilar-biological-products/ | La versión genérica de medicamentos más complicados. | [] | [] | [] | [] | [] | The generic version of more complicated medications. |
['glossary'] | ['glossary'] | [] | Benefits | Beneficios | /glossary/benefits/ | Los artículos o servicios médicos cubiertos por el plan. Los beneficios cubiertos y los servicios excluidos están definidos en los documentos de cobertura de... | [] | [] | [] | [] | [] | The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan's co... |
['glossary'] | ['glossary'] | [] | Benefit Year | Año de beneficios | /glossary/benefit-year/ | Un año de cobertura bajo un plan de seguro médico individual. El año de beneficios para los planes comprados dentro o fuera del mercado comienza el 1 de ener... | [] | [] | [] | [] | [] | A year of benefits coverage under an individual health insurance plan. The benefit year for plans bought inside or outside the Marketplace begins January 1 o... |
['glossary'] | ['glossary'] | [] | Balance Billing | Facturación del saldo | /glossary/balance-billing/ | Cantidad que un proveedor le cobra por la diferencia entre lo que él cobra y la cantidad autorizada. Por ejemplo, si el cargo del proveedor es de $100 y la c... | [] | [] | [] | [] | [] | When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allo... |
['glossary'] | ['glossary'] | [] | Appeal | Apelación | /glossary/appeal/ | Una solicitud para que su compañía de seguros o el Mercado revise una decisión que deniega un beneficio o pago.Si no está de acuerdo con una decisión toma... | [] | [] | [] | [] | [] | A request for your health insurance company or the Health Insurance Marketplace® to review a decision that denies a benefit or payment.If you don't agree ... |
['glossary'] | ['glossary'] | [] | Annual Limit | Límite anual | /glossary/annual-limit/ | Un límite en los beneficios que su compañía de seguros pagará en un periodo de un año mientras esté inscrito en un plan médico particular. Estos límites a ve... | [] | [] | [] | [] | [] | A cap on the benefits your insurance company will pay in a year while you're enrolled in a particular health insurance plan. These caps are sometimes placed ... |
['glossary'] | ['glossary'] | [] | Allowed Amount | Cantidad autorizada | /glossary/allowed-amount/ | La cantidad máxima que pagará el plan por los servicios médicos cubiertos. También se le conoce como "gasto elegible," "subsidio de pago" o "tarifa negociada... | [] | [] | [] | [] | [] | The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”If y... |
['glossary'] | ['glossary'] | [] | Affordable coverage | Cobertura accesible | /glossary/affordable-coverage/ | Un plan médico basado en un empleo que cubre sólo el empleado que cuesta 9.61% o menos de los ingresos familiares del empleado.Si un plan médico basado en ... | [] | [] | [] | [] | [] | A job-based health plan covering only the employee that costs 9.61% or less of the employee’s household income. If a job-based plan is “affordable,” and meet... |
['glossary'] | ['glossary'] | [] | Affordable Care Act (ACA) | Ley del Cuidado de Salud a Bajo Precio | /glossary/affordable-care-act/ | La ley de reforma de salud integral fue promulgada en marzo de 2010 (a veces conocida como ACA, PPACA u "Obamacare").La ley tiene 3 objetivos principales:... | [] | [] | [] | [] | [] | The comprehensive health care reform law enacted in March 2010 (sometimes known as ACA, PPACA, or “Obamacare”).The law has 3 primary goals:Make affordab... |
['glossary'] | ['glossary'] | [] | Actuarial Value | Valor Actuarial | /glossary/actuarial-value/ | El porcentaje promedio de los costos totales para beneficios cubiertos, que cubrirá un plan. Por ejemplo, si un plan tiene un valor actuarial del 70% en prom... | [] | [] | [] | [] | [] | The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you woul... |
['glossary'] | ['glossary'] | [] | Accountable Care Organization | Organización Responsable por el Cuidado de la Salud (ACO en inglés) | /glossary/accountable-care-organization/ | Un grupo de proveedores de servicios de salud que ofrecen atención coordinada, manejo de enfermedades crónicas y en consecuencia, mejoran la calidad de atenc... | [] | [] | [] | [] | [] | A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organizatio... |
['glossary'] | ['glossary'] | [] | Lawfully Present | Presente legalmente | /glossary/lawfully-present/ | "Presente legalmente” incluye a los inmigrantes:No ciudadanos calificados” sin período de esperaCon estatus humanitario o circunstancias especiales ( por... | [] | [] | [] | [] | [] | The term “lawfully present” is used to describe immigrants who have:“Qualified non-citizen” immigration status without a waiting periodHumanitarian statu... |
['glossary'] | ['glossary'] | [] | Zero Cost Sharing Plan | Planes de cero costos compartidos | /glossary/zero-cost-sharing-plan/ | Es un plan disponible para los miembros de tribus reconocidas y los accionistas de la corporación ANCSA cuyo ingreso está entre 100% al 300% del nivel de pob... | [] | [] | [] | [] | [] | A plan available to members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders whose income is between 1... |
['glossary'] | ['glossary'] | [] | Self-Employment Ledger | Libro de contabilidad de empleo por cuenta propia | /glossary/self-employment-ledger/ | Cualquier registro exacto y detallado de sus ingresos y gastos de su empleo por cuenta propia. Puede ser una hoja de cálculo, un documento de un programa de ... | [] | [] | [] | [] | [] | Any accurate, detailed record of your self-employment income and expenses. It can be a spreadsheet, a document from an accounting software program, a handwri... |
['glossary'] | ['glossary'] | [] | Reconcile | Ajustar | /glossary/reconcile/ | Cómo averiguar si ha utilizado la cantidad correcta de su crédito fiscal durante el año. Para conciliar, se comparan dos cantidades: el crédito fiscal que ut... | [] | [] | [] | [] | [] | How you find out if you used the right amount of premium tax credit during the year. To reconcile, you compare two amounts: the premium tax credit you used i... |
['glossary'] | ['glossary'] | [] | Minimum Value | Valor mínimo | /glossary/minimum-value/ | Un nivel de cobertura mínima que se aplica a los planes de salud basados en el empleo. Si el plan de su empleador cumple con esta norma y se considera "acces... | [] | [] | [] | [] | [] | A standard of minimum coverage that applies to job-based health plans. If your employer’s plan meets this standard and is considered “affordable,” you won’t ... |
['glossary'] | ['glossary'] | [] | Limited Cost Sharing Plan | Planes de costos compartidos limitados | /glossary/limited-cost-sharing-plan/ | Un plan disponible para los miembros de tribus reconocidas y accionistas de la Corporación ANCSA independientemente de los ingresos o su elegibilidad para lo... | [] | [] | [] | [] | [] | A plan available to members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders regardless of income or e... |