Insurance Abbreviations

Insurance abbreviations are frequently encountered in banking and insurance competitive exams. They are crucial for practical purposes within the insurance industry. This article provides a comprehensive list of insurance abbreviations from A to Z, along with their respective expanded forms.

List of Insurance Abbreviations (A-Z)

Healthcare Glossary

EHB: Essential Health Benefits are the minimum health coverage requirements that must be included in all health insurance plans sold on the Health Insurance Marketplace.

EMR: Electronic Medical Record is a digital version of a patient’s medical history, including their medical conditions, treatments, and medications.

EOB: Explanation of Benefits is a statement from your health insurance company that provides details about the medical services you received and the amount your insurance company paid for them.

EPO: Exclusive Provider Organization is a type of health insurance plan that requires you to use healthcare providers within the plan’s network.

EPSDT: Early Periodic Screening, Diagnostic & Treatment Services are preventive health services for children under the age of 21 who are enrolled in Medicaid or CHIP.

ERISA: Employee Retirement Income Security Act is a federal law that sets minimum standards for employee benefit plans, including health insurance plans.

ESI: Employee Sponsored Insurance is health insurance provided by an employer to their employees.

FFM/FFE: Federally Facilitated Marketplace/Federally Facilitated Exchange is the federal government’s online marketplace where individuals and small businesses can shop for health insurance plans.

FFS: Fee for Service is a type of health insurance plan in which you pay a fee for each medical service you receive.

FPL: Federal Poverty Level is a measure of income used to determine eligibility for various government programs, including health insurance subsidies.

FQHC: Federally Qualified Health Center is a community-based healthcare center that provides comprehensive primary care services to underserved populations.

FSA: Flexible Spending Amount is a tax-advantaged savings account that can be used to pay for qualified medical expenses.

HCR: Health Care Reform refers to the Affordable Care Act, which made significant changes to the U.S. healthcare system.

HCBS: Home & Community Based Services are long-term care services that are provided in a person’s home or community instead of a nursing home.

HHS: U.S Department of Health & Human Services is the federal agency responsible for administering various health programs, including Medicare and Medicaid.

HIPAA: Health Insurance Portability & Accountability Act is a federal law that protects the privacy of health information.

HIM/HIX: Health Insurance Marketplace/Health Insurance Exchange is a state-based or federal online marketplace where individuals and small businesses can shop for health insurance plans.

HMO: Health Maintenance Organization is a type of health insurance plan that requires you to use healthcare providers within the plan’s network.

HRP: High Risk Pool is a state-based program that provides health insurance to people with pre-existing conditions who are unable to obtain coverage through traditional health insurance plans.

HRSA: Health Resources & Services Administration is a federal agency that provides funding for healthcare services to underserved populations.

HSA: Health Savings Account is a tax-advantaged savings account that can be used to pay for qualified medical expenses.

HDHP: High Deductible Health Plan is a type of health insurance plan that has a high deductible but lower monthly premiums.

IPA: In-Person Assisters Program is a program that provides free or low-cost help to individuals and small businesses in shopping for health insurance plans on the Health Insurance Marketplace.

LTC: Long Term Care is a type of care that is provided to people who need assistance with activities of daily living, such as bathing, dressing, and eating.

MAGI: Modified Adjusted Gross Income is a measure of income used to determine eligibility for various government programs, including health insurance subsidies.

MA: Medicare Advantage is a type of Medicare health plan that is offered by private insurance companies.

MLR: Medical Loss Ratio is the percentage of premium revenue that health insurance companies must spend on medical care and quality improvement activities.

OEP: Open Enrollment Period is the time of year when individuals and small businesses can enroll in or change their health insurance plans on the Health Insurance Marketplace.

OON: Out of Network refers to healthcare providers who are not part of your health insurance plan’s network.

OOP: Out of Pocket refers to the amount of money you pay for healthcare services before your health insurance starts to cover the costs.

PBM: Pharmacy Benefit Manager is a company that manages prescription drug benefits for health insurance plans.

PCIP: Pre-existing Condition Insurance Plan is a temporary health insurance plan that was available to people with pre-existing conditions before the Affordable Care Act was implemented.

PCORI: Patient-Centered Outcomes Research Institute is a non-profit organization that funds research on patient-centered outcomes and comparative effectiveness of healthcare interventions.

PCP: Primary Care Provider is a healthcare provider who provides routine and preventive care to patients.

PDP: Prescription Drug Plan under Medicare Part D is a type of Medicare health plan that provides prescription drug coverage.

POS: Point-of-Service Plan is a type of health insurance plan that allows you to use healthcare providers both within and outside of the plan’s network.

PPO: Preferred Provider Organization is a type of health insurance plan that offers lower cost-sharing for using healthcare providers within the plan’s network.

QHP: Qualified Health Plan is a health insurance plan that meets the minimum standards set by the Affordable Care Act.

SBC: Summary of Benefits & Coverage is a document that provides a summary of the benefits and coverage of a health insurance plan.

SBM/SBE: State Based Marketplace/State Based Exchange is a state-based online marketplace where individuals and small businesses can shop for health insurance plans.

SEP: Special Enrollment Period is a time outside of the Open Enrollment Period when individuals and small businesses can enroll in or change their health insurance plans due to certain qualifying life events.

SHOP: Small Business Health Options Program is a federal program that provides tax credits to small businesses that offer health insurance to their employees.

SNF: Skilled Nursing Facility is a type of long-term care facility that provides skilled nursing care and rehabilitation services.

SPM/SPE: State Partnership Marketplace/State Partnership Exchange is a state-based online marketplace where individuals and small businesses can shop for health insurance plans.

SPP: Speciality Pharmacy Provider is a pharmacy that specializes in dispensing medications for complex or chronic conditions.

SSDI: Social Security Disability Income is a federal program that provides monthly benefits to people who are unable to work due to a disability.

SSI: Supplemental Security Income is a federal program that provides monthly benefits to people who are aged 65 or older, blind, or disabled and have limited income and resources.

TPA: Third Party Administrator is a company that administers health insurance plans on behalf of employers or insurance companies.

UCR: Usual, Customary & Reasonable Charges are the typical charges for medical services in a particular geographic area.

Insurance Abbreviations FAQs

What is insurance?

Insurance implies protection from financial loss by way of risk management against the risks of a contingent or uncertain loss.

Importance of Insurance Abbreviations

Knowing insurance abbreviations is crucial for practical purposes and exam preparations.

Types of Insurance

There are two main types of insurance:

• Life Insurance: Provides financial protection to the insured’s beneficiaries in the event of their death.
• Non-Life Insurance (General Insurance): Covers various risks and losses, such as property damage, vehicle accidents, and medical expenses.

Memorizing Insurance Abbreviations

Here are some tips for memorizing insurance abbreviations:

• Regular Mock Tests: Practice mock tests that include insurance abbreviations to familiarize yourself with them.
• Writing Practice: Write down insurance abbreviations and their full forms regularly to reinforce your memory.
• Relate to the Industry: Associate insurance abbreviations with real-life scenarios and industry practices to make them more memorable.