Association-sponsored plans: Professional or trade association-sponsored plans allow individuals to purchase health insurance through membership in business, trade or professional organizations. COBRA: The Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) is a federal law allowing employees and their dependents to continue participation in an employer-sponsored group health plan for a limited period (generally 18 months) after employment ends. Participants pay the full premiums associated with the plan, plus 2 percent to cover administrative costs. Coinsurance: Is the percentage of a medical bill that an insured person must pay, after deductibles and/or co-pays are met. While coinsurance is commonly 20 percent, it can be as little as zero or as much as 50 percent (for out-of-network services, for example). Continuous coverage: Coverage that is not interrupted by a lapse of 63 or more days in a row. Co-payment: A co-payment, or co-pay, is a fixed-dollar amount insured persons pay each time they seek care or purchase covered items, such as office visits or prescription drugs. Co-pays sometimes apply to inpatient hospital stays. Health plans usually have separate co-pay requirements for prescription drugs. Deductible: Is the amount that insured persons must pay for covered services before medical expenses are paid by the health plan. Some plans have separate deductibles for pharmacy benefits. Employee cost sharing: Employee cost sharing refers to the portion of health insurance costs—above and beyond the premium contribution—that employees are expected to pay out-of-pocket. Employee cost sharing expenses include deductibles, co-payments and coinsurance. Fee-for-service (FFS) health insurance: This was once the most common kind of health care policy. This type of health insurance offers the most choices of doctors and hospitals. You can choose any doctor you wish and change doctors any time. You can go to any hospital in any part of the country. Also known as indemnity or traditional health insurance. Guaranteed issue: Federal law prohibits insurance companies from denying health coverage to individuals on the basis of health status or other factors related to the use of health care. Guaranteed renewability:Federal law prohibits insurance companies from canceling an individual's insurance because they become sick. Health Status. Refers to your medical condition (both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), and disability. HMO: A health maintenance organization (HMO) is an insurance plan that requires a person to get care from providers who are part of the HMOs network. Usually, a primary care provider coordinates care and controls access to specialists. Most HMOs offer a point-of-service (POS) option for additional fees. HSA: A health savings account (HSA) is an alternative to traditional insurance coverage. HSAs must be paired with a high-deductible health insurance policy, the contribution to which is tax-deductible. HSA funds may be used to pay out-of-pocket costs (deductibles, coinsurance, co-pays). The employer, the employee or both may fund the plan. HSA accounts are owned by the employee, are fully portable and remaining balances roll over year to year. High-risk pools: 32 states operate high-risk pools for individuals who are denied insurance on the basis of poor health status. Eligibility rules vary, but many states require enrollees to have been denied coverage from insurance carriers or to have certain high-cost conditions. HIPAA: The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law that includes important health insurance provisions, including non-discrimination, guaranteed renewability, guaranteed issue and limits to benefit exclusions due to pre-existing medical conditions. Maximum out-of-pocket expenditures: This out-of-pocket limit is the maximum amount of cost sharing an insured individual or family would have to pay in a given year. Once a maximum out-of-pocket limit is reached, the insurer pays all additional covered medical expenses for the year, up to the plan’s limit. Medical underwriting: Medical underwriting is a practice used by insurance companies to assess an individual’s health status and determine whether to issue coverage. Insurers also use medical underwriting to adjust premiums (usually upward) based on an individual’s health status or medical claims experience. Non-discrimination: Neither insurers nor employers are permitted to condition eligibility of employees and their dependents on their health status. Open access plan: An open access (OA) plan is an HMO or POS plan in which patients are allowed to self-refer to specialists for a higher co-pay. Point-of-service: A point-of-service (POS) plan is an option added to many HMOs allowing enrollees to seek care outside of the HMOs network for a higher co-pay and, possibly, a higher premium. PPO: A preferred provider organization (PPO) is an insurance plan that encourages enrollees to get care from providers within the plan’s network, but allows access to providers outside the network if one is willing to pay more. Many PPOs do not require the insured person to choose a primary care doctor or get a referral to see a specialist. Pre-existing medical condition: A pre-existing medical condition is one for which an individual actually received care, treatment, or medical advice during a period of time (e.g., 6 or 12 months) before coverage went into effect. Pre-existing medical conditions, such as asthma, diabetes, or cancer may increase the cost and in some cases availability of insurance, subject to federal and state laws and a carrier's policies. Premiums: The premium is the amount an insurance plan costs per month. Premiums may vary as a function of market conditions, plan types, health status of enrollees, number of enrollees and degree of employee cost sharing. Typically, the employer and employee each contribute to the premium payment. Provider choice: Different plan types (HMOs, PPOs, POS plans and OA plans) vary with respect to the degree of choice enrollees have as to which doctors or other health care providers they wish to see. HMOs have the least provider choice, as they require participants to see professionals only within the plan’s relatively narrow network, whereas PPOs tend to have broader networks of preferred providers and allow access to non-network providers, but at a higher cost. Rate-up: A rate-up is the extent to which premiums are increased, usually annually. Premium rate-ups are typically expressed as a percentage increase. For example, a premium that increases from $1,000 per year to $1,100 per year has a rate-up of 10 percent.