QHP Terminology

A 60 day timeframe the customer has to select a plan if they report a qualifying life event.

A place where you can check how much of your deductible you have paid off for the current policy year

A list of life events established by HSRI that can qualify a customer for a Special Enrollment Period.

A time of year between November 1 and January 31 where QHP eligible individuals can renew or change their plan.

When a customer is going to be auto-renewed for the following policy year.

When a customer has been enrolled into coverage and is now terminated due to non-payment or an eligibility change.

Information sent from the carrier each morning that displays the customer's paid through date and enrollment status.

A process to clear income verification data points. This can be done through the customer portal.

A fixed amount you pay for a covered service...

When a customer makes their binder payment and they are currently active.

The first payment a customer makes for their plan. Without this the customer will not be active.

Reduces co-pays , co-insurance, deductibles and maximum out of pocket costs.

Household members who are on a QHP policy. This is not the primary or the oldest HH member.

A population of individuals who can be granted an SEP once a month.

Funds from their employer that is used to purchase health insurance through HSRI.

Usually on the carrier website, this is where you can see how your prescriptions are covered.

When a customer is enrolled but has not made their binder payment yet.

This is 90 days for customers with APTCs and 30 days for customers without APTCs...

When a customer has failed to make their binder payment in time.

This is the max amount you will pay out of pocket for a policy year. Included, deductible. copays and co insurance.

A subsidy awarded by the government to help reduce the premium cost.

The PA or the oldest member of the HH on a QHP policy.