Decoding Health Care Reform & the Health Insurance Exchange

While most of us can understand the basic meanings of our health insurance terminology such as deductibles, co-pays, co-insurance, etc., there is a whole new language being spoken within Health Care Reform.

Wondering what in the world an EHB or QHP is? This list should help.


ACA – Affordable Care Act, fully known as PPACA or the Patient Protection and Affordable Care Act, is the federal statute signed into law on March 23, 2010.

ASO – Administrative Services Only, commonly referring to a Self-Funded insurance plan that an employer funds itself. Self-Funded groups will not be required to meet all or the same mandates as Fully-Funded insurance carriers.

EHB – Essential Health Benefits, the key components of what a health insurance plan must offer beginning January 1, 2014.

FPL – Federal Poverty Level, this will determine who is eligible for a government subsidy within the Colorado Health Insurance Exchange as well as who is eligible for Medicaid.

FTE – Full Time Equivalent, this determines an employer’s group size and whether or not the employer qualifies for government subsidies within the Colorado Health Insurance Exchange.

HHS – Health and Human Services, the federal government’s principal agency that is administering the ┬áPatient Protection and Affordable Care Act.

OPM – Out of Pocket Maximum, this amount determines the maximum dollar amount that you’ll end up spending in a year on your healthcare costs while using your insurance plan. It will apply across the board, to all qualified health insurance plans in or out of the Colorado Health Insurance Exchange but the exact amount has not been released yet.

SBC – Summary of Benefits and Coverage,┬áthis is intended to be a short, easy-to-read document that will help you better understand the terms of your coverage. Read our post specifically about SBC’s here.

SHOP – Small Business Health Options Program, this is the exchange that Small Business Employers will operate within come 2014.

QHP – Qualified Health Plan, a certified health plan that provides Essential Health Benefits, meets required mandates and is offered by a licensed health insurer.

This list is just the beginning of the new language that will be spoken in 2014 but fortunately, we speak it fluently so you don’t have to! We can help you decode those acronyms and find your way through the Colorado Health Insurance Exchange.