The Blue Jay Advisors Health Insurance Glossary

Health insurance can be confusing, but it doesn’t have to be. Blue Jay Advisors maintains this Health Insurance Glossary to help you make sense of the terms and concepts that often feel overwhelming. Whether you’re comparing Marketplace plans, wondering what “deductible” really means, or trying to understand your financial help options, this guide breaks it all down in plain language. Click a letter range below to quickly find the definitions you need and feel more confident about your coverage choices. As always, a licensed professional is just a click or a call away.

A-D E-M N-Z

A-D

Advance Premium Tax Credit (APTC)

A tax credit you can apply in advance to lower your monthly health insurance payment (or “premium”). When you apply for coverage on Pennie®, you estimate your expected income for the year..

Affordable Care Act (ACA)

A federal law passed in 2010 that expanded access to health insurance, created Health Insurance Marketplaces, and provides financial help to lower monthly premiums.

Annual Deductible

The amount you must pay out of pocket each year for covered health care before your insurance starts paying its share.

Coinsurance

Your share of the costs of a covered service, shown as a percentage (for example, 20%). If your visit costs $100, you pay $20 and your insurer pays $80.

Copayment (Copay)

A fixed dollar amount you pay for certain health services, like $25 for a doctor visit or $10 for a prescription.

Cost Sharing Reductions (CSRs)

A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. At Pennie®, cost-sharing reductions are often called “financial savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings.

Coverage Year

The 12-month period your health plan is active, often January through December.

Dependent

A person covered under your plan, usually a spouse, child, or other family member.

E-M

Eligibility

The criteria you must meet to enroll in a health plan or qualify for savings, such as income or household size.

Enrollment Period

The window of time each year when you can sign up for or change your health plan.

Essential Health Benefits (EHB)

A set of 10 categories of services (like maternity care, prescription drugs, and mental health) that all Marketplace plans must cover.

Formulary

A list of prescription drugs covered by your health plan.

Health Insurance Marketplace

An online platform (like HealthCare.gov or Pennie) where individuals and families can compare plans, find out if they qualify for savings, and enroll in coverage.

In-Network Provider

A doctor, hospital, or clinic that contracts with your insurance company, meaning you’ll pay less when you use them.

Medicaid (MA)

A free or low-cost health insurance program for people with limited income, funded by both federal and state governments.

N-Z

Network

The group of doctors, hospitals, and other providers your insurance company works with.

Out-of-Network Provider

A provider who doesn’t contract with your insurance. Care from them usually costs more.

Premium

The amount you pay each month to keep your health insurance active.

Preventive Care

Routine health services like checkups, vaccines, and screenings — usually covered at no cost to you.

Prescription Drug Coverage

Our plans provide coverage for prescription drugs, including both brand-name and generic medications.

Qualified Health Plan (QHP)

A health plan certified by the Marketplace that meets ACA standards for coverage and consumer protections.

Qualifying Life Event (QLE)

A change in your situation, getting married, having a baby, or losing health coverage for example, which can make you eligible for a Special Enrollment Period (SEP), allowing you to enroll in health insurance outside the yearly Open Enrollment Period (OEP).

Special Enrollment Period (SEP)

A time outside of open enrollment when you can sign up for coverage due to a qualifying life event (QLE) or change in circumstance (CIC) like losing other coverage, getting married, or having a baby.

Subsidy

Financial help from the government that lowers your monthly premium or out-of-pocket costs. See also APTC or CSR