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['glossary']
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['glossary']
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[]
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Guaranteed Renewal
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Renovación garantizada
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/glossary/guaranteed-renewal/
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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...
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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...
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['glossary']
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['glossary']
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[]
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Guaranteed Issue
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Emisión garantizada
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/glossary/guaranteed-issue/
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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...
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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...
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['glossary']
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['glossary']
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[]
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Grievance
|
Queja
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/glossary/grievance/
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Una queja que usted comunica a su asegurador o plan médico.
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[]
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[]
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A complaint that you communicate to your health insurer or plan.
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['glossary']
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['glossary']
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[]
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Grandfathered
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Planes con “derechos adquiridos” (grandfathered)
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/glossary/grandfathered/
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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.
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[]
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As used in connection with the Affordable Care Act: Exempt from certain provisions of this law.
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['glossary']
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['glossary']
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[]
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Grandfathered Health Plan
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Plan de “derechos adquiridos”
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/glossary/grandfathered-health-plan/
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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 ...
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[]
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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...
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['glossary']
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['glossary']
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[]
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Fully Insured Job-based Plan
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Plan de seguro total subsidiado por el empleador
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/glossary/fully-insured-job-based-plan/
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Un plan médico de una compañía de seguros comprado por un empleador.
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[]
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[]
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[]
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A health plan purchased by an employer from an insurance company.
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['glossary']
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['glossary']
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[]
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Formulary
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Formulario - Lista de medicamentos
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/glossary/formulary/
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Una lista de medicamentos cubiertos por un plan de medicamentos recetados u otro plan médico que ofrezca beneficios de medicamentos recetados. También conoci...
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A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.
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['glossary']
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['glossary']
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[]
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Flexible Spending Account (FSA)
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Cuenta de Gastos Flexible (FSA en inglés)
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/glossary/flexible-spending-account-fsa/
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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...
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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...
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['glossary']
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['glossary']
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[]
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Flexible Benefits Plan
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Plan de beneficios flexible
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/glossary/flexible-benefits-plan/
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Programa de beneficios que ofrece a los empleados elegir entre varios beneficios, incluyendo dinero en efectivo, seguro de vida, seguro médico, vacaciones, p...
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A benefit program that offers employees a choice between various benefits including cash, life insurance, health insurance, vacations, retirement plans, and ...
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['glossary']
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['glossary']
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[]
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Federally Qualified Health Center (FQHC)
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Centro de Salud Federalmente Calificado (FQHC en inglés)
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/glossary/federally-qualified-health-center-fqhc/
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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...
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Federally funded nonprofit health centers or clinics that serve medically underserved areas and populations. Federally qualified health centers provide prima...
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['glossary']
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['glossary']
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[]
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Federal Poverty Level (FPL)
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Índice Federal de Pobreza (FPL en inglés)
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/glossary/federal-poverty-level-fpl/
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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...
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[]
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[]
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[]
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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...
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['glossary']
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['glossary']
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[]
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Family and Medical Leave Act (FMLA)
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Ley de Licencia Familiar y Médica (FMLA en inglés)
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/glossary/family-and-medical-leave-act-fmla/
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Una ley federal que garantiza hasta 12 semanas de licencia de trabajo con protección para determinados empleados cuando necesitan tomarse tiempo libre por un...
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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...
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['glossary']
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['glossary']
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[]
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Exclusive Provider Organization (EPO) Plan
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Plan de organizaciones de proveedores exclusivos (EPO en inglés)
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/glossary/exclusive-provider-organization-epo-plan/
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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...
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[]
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[]
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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 ...
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['glossary']
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['glossary']
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[]
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Excluded Services
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Servicios excluidos
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/glossary/excluded-services/
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Servicios médicos que su seguro o plan médico no cubren y no pagan.
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Health care services that your health insurance or plan doesn’t pay for or cover.
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['glossary']
|
['glossary']
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[]
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Exchange
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Intercambio de seguros
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/glossary/exchange/
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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 ...
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[]
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Another term for the Health Insurance Marketplace®, a service available in every state that helps individuals, families, and small businesses shop for and en...
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['glossary']
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['glossary']
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[]
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Essential Health Benefits
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Beneficios/Beneficios de salud esenciales
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/glossary/essential-health-benefits/
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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...
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[]
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[]
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[]
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[]
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A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient...
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['glossary']
|
['glossary']
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[]
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Employer Shared Responsibility Payment (ESRP)
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Pago por responsabilidad compartida del empleador (ESRP en inglés)
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/glossary/employer-shared-responsibility-payment/
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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...
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[]
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[]
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[]
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[]
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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 ...
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['glossary']
|
['glossary']
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[]
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Emergency Services
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Servicios de emergencia
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/glossary/emergency-services/
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Evaluación de una condición médica de emergencia y del tratamiento adecuado para evitar que esa condición empeore.
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Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
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['glossary']
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['glossary']
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[]
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Emergency Room Care
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Cuidados de emergencia
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/glossary/emergency-room-care/
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Servicios que recibe en una sala de emergencias.
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[]
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[]
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Emergency services you get in an emergency room.
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['glossary']
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['glossary']
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[]
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Emergency Medical Transportation
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Transporte médico de emergencia
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/glossary/emergency-medical-transportation/
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Servicios de ambulancia en caso de una condición médica de emergencia.
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[]
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[]
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[]
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[]
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Ambulance services for an emergency medical condition.
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['glossary']
|
['glossary']
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[]
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Emergency Medical Condition
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Condición médica de emergencia
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/glossary/emergency-medical-condition/
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Una enfermedad, lesión, síntoma o enfermedad tan grave, que cualquier persona razonable buscaría atención de inmediato para evitar un daño grave.
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[]
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An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.
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['glossary']
|
['glossary']
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[]
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Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)
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Servicios de detección temprana y periódica, diagnóstico, y tratamiento (EPSDT en inglés)
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/glossary/early-and-periodic-screening-diagnostic-and-treatment-services-epsdt/
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Término usado para referirse al conjunto de beneficios completos cubiertos para los niños bajo Medicaid.
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[]
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[]
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[]
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[]
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[]
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A term used to refer to the comprehensive set of benefits covered for children in Medicaid.
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['glossary']
|
['glossary']
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[]
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Durable Medical Equipment (DME)
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Equipo Médico Duradero (DME en inglés)
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/glossary/durable-medical-quipment-dme/
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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...
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Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches ...
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['glossary']
|
['glossary']
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[]
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Donut Hole, Medicare Prescription Drug
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Interrupción de la cobertura de las recetas médicas (“Donut hole”).
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/glossary/donut-hole-medicare-prescription-drug/
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La mayoría de los planes con cobertura de medicamentos recetados de Medicare (Parte D) tienen una interrupción de cobertura (conocida como "donut hole"). Est...
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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...
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['glossary']
|
['glossary']
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[]
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Disability
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Incapacidad
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/glossary/disability/
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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...
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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...
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['glossary']
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['glossary']
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[]
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Dependent Coverage
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Cobertura de dependientes
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/glossary/dependent-coverage/
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Cobertura médica para miembros de la familia del beneficiario de la póliza, tales como cónyuge, niños o pareja.
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Insurance coverage for family members of the policyholder, such as spouses, children, or partners.
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['glossary']
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['glossary']
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[]
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Creditable Coverage
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Cobertura válida
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/glossary/creditable-coverage/
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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...
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Health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance; Medicare; Medicaid; CHAMPUS...
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['glossary']
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['glossary']
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[]
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Cost Sharing
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Costos compartidos
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/glossary/cost-sharing/
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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...
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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...
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['glossary']
|
['glossary']
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[]
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Conversion
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Conversión
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/glossary/conversion/
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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...
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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...
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['glossary']
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['glossary']
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[]
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Complication of Pregnancy
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Complicaciones durante el embarazo
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/glossary/complications-of-pregnancy/
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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 ...
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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 ...
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['glossary']
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['glossary']
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[]
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Competitive Bidding
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Oferta competitiva (subasta)
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/glossary/competitive-bidding/
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Una subasta abierta para contratos federales entre grupos independientes que compiten por el contrato presentando la mejor oferta.
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Open bidding for federal contracts between independent groups that compete for the contract by providing the best bid.
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['glossary']
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['glossary']
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[]
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Community Rating
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Calificación comunitaria
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/glossary/community-rating/
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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.
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A rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors.
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['glossary']
|
['glossary']
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[]
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COBRA
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COBRA
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/glossary/cobra/
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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...
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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...
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['glossary']
|
['glossary']
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[]
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Copayment
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Copago
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/glossary/co-payment/
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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...
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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...
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['glossary']
|
['glossary']
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[]
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Coinsurance
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Coseguro
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/glossary/co-insurance/
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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 ...
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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'...
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['glossary']
|
['glossary']
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[]
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Claim
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Reclamación
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/glossary/claim/
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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...
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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.
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['glossary']
|
['glossary']
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[]
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Chronic Disease Management
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Control de enfermedades crónicas
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/glossary/chronic-disease-management/
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Un enfoque de atención integrada que permite controlar las enfermedades que requieren controles médicos, exámenes, tratamiento de monitoreo y coordinación y ...
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An integrated care approach to managing illness which includes screenings, check-ups, monitoring and coordinating treatment, and patient education. It can im...
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['glossary']
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['glossary']
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[]
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Children's Health Insurance Program (CHIP)
|
Programa de Seguro Médico para Niños (CHIP)
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/glossary/childrens-health-insurance-program-chip/
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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...
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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...
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['glossary']
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['glossary']
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[]
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Catastrophic Health Plan
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Plan Catastrófico
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/glossary/catastrophic-health-plan/
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Planes médicos que cumplen todos los requisitos aplicables a otros Planes Médicos Calificados (QHP) pero que no cubren ningún beneficio excepto por 3 visita...
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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...
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['glossary']
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['glossary']
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[]
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Care Coordination
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Coordinación del cuidado de la salud
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/glossary/care-coordination/
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La coordinación de su tratamiento a través de varios proveedores de servicios de salud. Los hogares médicos y las organizaciones responsables de la atención,...
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[]
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[]
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The organization of your treatment across several health care providers. Medical homes and Accountable Care Organizations are two common ways to coordinate c...
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['glossary']
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['glossary']
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[]
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Biosimilar Biological Products
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Biosimilares Productos Biológicos
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/glossary/biosimilar-biological-products/
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La versión genérica de medicamentos más complicados.
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[]
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The generic version of more complicated medications.
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['glossary']
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['glossary']
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[]
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Benefits
|
Beneficios
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/glossary/benefits/
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Los artículos o servicios médicos cubiertos por el plan. Los beneficios cubiertos y los servicios excluidos están definidos en los documentos de cobertura de...
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[]
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[]
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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...
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['glossary']
|
['glossary']
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[]
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Benefit Year
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Año de beneficios
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/glossary/benefit-year/
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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...
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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...
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['glossary']
|
['glossary']
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[]
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Balance Billing
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Facturación del saldo
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/glossary/balance-billing/
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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...
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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...
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['glossary']
|
['glossary']
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[]
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Appeal
|
Apelación
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/glossary/appeal/
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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...
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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 ...
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['glossary']
|
['glossary']
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[]
|
Annual Limit
|
Límite anual
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/glossary/annual-limit/
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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...
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[]
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[]
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[]
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[]
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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 ...
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['glossary']
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['glossary']
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[]
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Allowed Amount
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Cantidad autorizada
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/glossary/allowed-amount/
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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...
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[]
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[]
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[]
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[]
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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...
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['glossary']
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['glossary']
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[]
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Affordable coverage
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Cobertura accesible
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/glossary/affordable-coverage/
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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 ...
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[]
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[]
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[]
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[]
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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...
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['glossary']
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['glossary']
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[]
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Affordable Care Act (ACA)
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Ley del Cuidado de Salud a Bajo Precio
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/glossary/affordable-care-act/
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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:...
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[]
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[]
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[]
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[]
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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...
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['glossary']
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['glossary']
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[]
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Actuarial Value
|
Valor Actuarial
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/glossary/actuarial-value/
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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...
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[]
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[]
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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...
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['glossary']
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['glossary']
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[]
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Accountable Care Organization
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Organización Responsable por el Cuidado de la Salud (ACO en inglés)
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/glossary/accountable-care-organization/
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Un grupo de proveedores de servicios de salud que ofrecen atención coordinada, manejo de enfermedades crónicas y en consecuencia, mejoran la calidad de atenc...
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[]
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[]
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[]
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[]
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A group of health care providers who give coordinated care, chronic disease management, and thereby improve the quality of care patients get. The organizatio...
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['glossary']
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['glossary']
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[]
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Lawfully Present
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Presente legalmente
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/glossary/lawfully-present/
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"Presente legalmente” incluye a los inmigrantes:No ciudadanos calificados” sin período de esperaCon estatus humanitario o circunstancias especiales ( por...
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[]
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[]
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[]
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[]
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[]
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The term “lawfully present” is used to describe immigrants who have:“Qualified non-citizen” immigration status without a waiting periodHumanitarian statu...
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['glossary']
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['glossary']
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[]
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Zero Cost Sharing Plan
|
Planes de cero costos compartidos
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/glossary/zero-cost-sharing-plan/
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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...
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[]
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[]
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[]
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[]
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[]
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A plan available to members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders whose income is between 1...
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['glossary']
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['glossary']
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[]
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Self-Employment Ledger
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Libro de contabilidad de empleo por cuenta propia
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/glossary/self-employment-ledger/
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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 ...
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[]
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[]
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[]
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[]
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[]
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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...
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['glossary']
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['glossary']
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[]
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Reconcile
|
Ajustar
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/glossary/reconcile/
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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...
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[]
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[]
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[]
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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...
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['glossary']
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['glossary']
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[]
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Minimum Value
|
Valor mínimo
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/glossary/minimum-value/
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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...
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[]
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[]
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[]
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[]
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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 ...
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['glossary']
|
['glossary']
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[]
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Limited Cost Sharing Plan
|
Planes de costos compartidos limitados
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/glossary/limited-cost-sharing-plan/
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Un plan disponible para los miembros de tribus reconocidas y accionistas de la Corporación ANCSA independientemente de los ingresos o su elegibilidad para lo...
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[]
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[]
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[]
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[]
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[]
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A plan available to members of federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders regardless of income or e...
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