Alternative Trade Adjustment Assistance (ATAA).  ATAA is a benefit for workers at least 50 years old who have obtained different, full-time employment within 26 weeks of the termination of adversely-affected employment.  These workers may receive 50% of the wage differential (up to $10,000) during their 2 year eligibility period.  To be eligible for the ATAA program, workers may not earn more than $50,000 per year in their new employment.  Also, the worker’s old firm must meet certain eligibility criteria.

Certificate of Creditable Coverage.  A document provided by your health plan that lets you prove you had coverage under that plan.  Certificates of creditable coverage will usually be provided automatically when you leave a health plan.  You can obtain certificates at other times as well.  See also Creditable Coverage.

COBRA.  Stands for the Consolidated Omnibus Budget Reconciliation Act, a federal law in effect since 1986.  COBRA permits you and your dependents to continue in your employer’s group health plan after your job ends.  If your employer has 20 or more employees, you may be eligible for COBRA continuation coverage when you retire, quit, are fired, or work reduced hours.  Continuation coverage also extends to surviving, divorced or separated spouses; dependent children; and children who lose their dependent status under their parent’s plan rules. You may choose to continue in the group health plan for a limited time and pay the full premium (including the share your employer used to pay on your behalf).  COBRA continuation coverage generally lasts 18 months, or 36 months for dependents in certain circumstances.  See also State Continuation Coverage.

Continuous Coverage.  Under federal rules, health insurance coverage that is not interrupted by a break of 63 or more days in a row.  Employer waiting periods do not count as gaps in health insurance coverage for the purpose of determining if coverage is continuous.  Federal rules apply to you if you are joining a self-insured group health plan.  See also Creditable Coverage.

Creditable Coverage.  Health insurance coverage under any of the following: a group health plan; individual health insurance; student health insurance in Colorado; Medicare; Medicaid; CHAMPUS and TRICARE (health coverage for military personnel, retirees, and dependents); the Federal Employees Health Benefits Program; Indian Health Service; the Peace Corps; Public Health Plan (any plan established or maintained by a State, the U.S. government, a foreign country); State Children’s Health Insurance Program; or a state health insurance high risk pool.  See also Continuous Coverage, Group Health Plan, Individual Health Insurance.

Dirigo Health Program.  The Dirigo Health Program is a state-sponsored arrangement that provides health insurance to individuals, small groups, and self-employed persons.  This arrangement is intended to provide access to affordable health insurance to those individuals who otherwise would be left uninsured.

Elimination Rider.  An amendment permitted in individual health insurance policies that permanently excludes coverage for a health condition, body part, or body system.  Elimination riders are not permitted in Maine.

Enrollment Period.  The period during which all employees and their dependents can sign up for coverage under an employer group health plan.  Besides permitting workers to elect health benefits when first hired, many employers and group health insurers hold an annual enrollment period, during which all employees can enroll in or change their health coverage.  See also Group Health Plan, Special Enrollment Period.

Family and Medical Leave Act (FMLA). 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, to have or adopt a child, or to care for another family member.  When you qualify for leave under FMLA, you can continue coverage under your group health plan.

Fully Insured Group Health Plan. Health plan purchased by an employer from an insurance company.  Fully insured health plans are regulated by Maine.  See also Self-Insured Group Health Plans.

Genetic Information.  Includes information about family history or genetic test results indicating your risk of developing a health condition.  A health plan cannot consider pre-existing (and therefore exclude coverage for) a condition about which you have genetic information, unless that health condition has been diagnosed by a health professional.

Group Health Plan.  Health insurance (usually sponsored by an employer, union or professional association) that covers at least 2 employees.  See also Fully Insured Group Health Plan, Self-Insured Group Health Plan.

Guaranteed Issue.  A requirement that health plans must permit you to enroll regardless of your health status, age, gender, or other factors that might predict your use of health services.  All health plans sold to individuals and small employers in Maine are guaranteed issue.  Plans that are guaranteed issue can turn you away for other reasons.

Guaranteed Renewability.  A feature in health plans that means your coverage cannot be canceled because you get sick.  HIPAA requires all health plans to be guaranteed renewable.  Your coverage can be canceled for other reasons unrelated to your health status.

Health Coverage Tax Credit (HCTC). The Health Coverage Tax Credit (HCTC) is a program that can help pay for nearly two-thirds of eligible individuals’ health plan premiums. In general, in order to be eligible for the health coverage tax credit, you must be 1) receiving Trade Readjustment Allowance benefits (TRA), or 2) will receive TRA benefits once your unemployment benefits are exhausted, or 3) receiving benefits under the Alternative Trade Adjustment Assistance (ATAA) program, or 4) aged 55 or older and receiving benefits from the Pension Benefit Guaranty Corporation (PBGC).

Health Insurance or Health Plan.  In this guide, the term means benefits consisting of medical care (provided directly or through insurance or reimbursement) under any hospital or medical service policy, plan contract, or HMO contract offered by a health insurance company or a group health plan.  It does not mean coverage that is limited to accident or disability insurance, workers’ compensation insurance, liability insurance (including automobile insurance) for medical expenses, or coverage for on-site medical clinics.  Health insurance also does not mean coverage for limited dental or vision benefits to the extent these are provided under a separate policy.

Health Status.  When used in this guide, refers to your medical condition (both physical and mental illnesses), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), and disability.  See also Genetic Information.

HIPAA.  The Health Insurance Portability and Accountability Act was passed in 1996 to help people buy and keep health insurance, even when they have serious health conditions, the law sets a national floor for health insurance reforms.  Since states can and have modified and expanded upon these provisions, consumers’ protections vary from state to state.

HIPAA Eligible.  Status you attain once you have had 18 months of continuous creditable health coverage.  To be HIPAA eligible, you also must have used up any COBRA or state continuation coverage; you must not be eligible for Medicare or Medicaid; you must not have other health insurance; and you must apply for individual health insurance within 63 days of losing your prior creditable coverage.  When you are buying an individual health insurance policy, HIPAA eligibility gives you greater protections than you would otherwise have in Maine and in other states.  See also COBRA, Continuous Coverage, Creditable Coverage, State Continuation Coverage.

HMO.  Health maintenance organization.  A kind of health insurance plan.  HMOs usually limit coverage to care from doctors who work for or contract with the HMO.  They generally do not require deductibles, but often do charge a small fee, called a copayment, for services like doctor visits or prescriptions. HMOs in the individual market in Maine must offer a point of service (POS) option, which permits you to get care from providers outside the HMO network. You will pay a greater share of charges when you get care under the POS option.  See also Point-of-Service (POS).

Individual Health Insurance Policy.  Policies for people not connected to an employer group.  The term also refers to coverage purchased by the self-employed for themselves (or their family members) but for no other employees.  Individual health insurance is regulated by Maine.

Large Group Health Plan.  One sponsored by an employer with more than 50 employees.

Late Enrollment.  Enrollment in a health plan at a time other than the regular or a special enrollment period.  If you are a late enrollee, you may be subject to a longer pre-existing condition exclusion period.  See also Special Enrollment Period.

Look Back.  The maximum length of time, immediately prior to enrolling in a health plan, which can be examined for evidence of pre-existing conditions.  See also Pre-existing Condition.

Maine Breast and Cervical Health Program (MBCHP).  Program which provides free screening for breast and cervical cancer to eligible Maine residents.  Eligible women diagnosed with breast or cervical cancer may be eligible for free coverage through Medicaid for treatment of their condition.

Medicaid.  A program providing comprehensive health insurance coverage and other assistance to certain low-income Maine residents.  All other states have Medicaid programs, too, though eligibility levels and covered benefits will vary.

Modified Community Rating.  A rule that prohibits health plans in Maine from varying premiums based on health status. Small group and individual health insurance premiums are subject to modified community rating.

Nondiscrimination.  A requirement that group health plans not discriminate against you based on your health status.  Your coverage under a group health plan cannot be denied or restricted, nor can you be charged a higher premium, because of your health status.  Group health plans can restrict your coverage based on other factors (such as part time employment) that are unrelated to health status.  See also Group Health Plan, Health Status.

Pension Benefit Guaranty Corporation (PBGC).  PBGC is a federal government corporation established by Title IV of the Employee Retirement Income Security Act of 1974 (ERISA) to encourage the continuation and maintenance of defined benefit pension plans, and provide timely and uninterrupted payment of pension benefits to participants and beneficiaries in plans covered by PBGC.  It currently guarantees payment of basic pension benefits earned by American workers and retirees participating in private-sector defined benefit pension plans.  The agency receives no funds from general tax revenues.  Operations are financed largely by insurance premiums paid by companies that sponsor pension plans and by PBGC’s investment returns.

Point-of-Service (POS).  A type of managed care plan that lets you decide whether to get care from providers in or out of the HMO network.  When you get care in-network, your out-of-pocket costs will be less than if you get care outside of the network.  See also HMO. 

Pre-existing Condition.  Any condition (either physical or mental) for which medical advice, diagnosis, care, or treatment was recommended or received within the 6-month period immediately preceding enrollment in a health plan.  Pregnancy cannot be counted as a pre-existing condition.  Genetic information about your likelihood of developing a disease or condition, without a diagnosis of that disease or condition, cannot be considered a pre-existing condition.  Newborns, newly adopted children, and children placed for adoption covered within 30 days cannot be subject to pre-existing condition exclusions.

Pre-existing Condition Exclusion Period.  The time during which a health plan will not pay for covered care relating to a pre-existing condition.  See also Pre-existing Condition.

Self-Insured Group Health Plans.  Plans set up by employers who set aside funds to pay their employees’ health claims.  Because employers often hire insurance companies to run these plans, they may look to you just like fully insured plans.  Employers must disclose in your benefits information whether an insurer is responsible for funding, or for only administering the plan.  If the insurer is only administering the plan, it is self-insured.  Self-insured plans are regulated by the U.S. Department of Labor, not by Maine.  However, self-insured plans that are also state or local government plans are regulated by the state of Maine and subject to state law.

Small Group Health Plans.  Plans with at least 2 but not more than 50 employees.

Special Enrollment Period.  A time, triggered by certain specific events, during which you and your dependents must be permitted to sign up for coverage under a group health plan. Employers and group health insurers must make such a period available to employees and their dependents when their family status changes or when their health insurance status changes.  Special enrollment periods must last at least 30 days.  Enrollment in a health plan during a special enrollment period is not considered late enrollment.  See also Late Enrollment.

State Continuation Coverage.  A program similar to COBRA, although COBRA does not apply to employers with fewer than 20 employees.  In Maine, if you are in a fully insured group health plan, you may also have rights to continue your health coverage for up to 12 months when you lose your coverage because you were temporarily laid off or had a work related illness or injury. See also COBRA.

Supplemental Security Income (SSI).  A program providing cash benefits to certain very low-income disabled and elderly individuals.  When you qualify for SSI, you generally also qualify for Medicaid.  In addition, Medicaid coverage often continues for a limited time if your income increases so that you no longer qualify for SSI.

Temporary Assistance for Needy Families (TANF). A program (also known as the Family Assistance Program or FAP) that provides cash benefits to low-income families with children.  When you qualify for TANF, you generally also qualify for Medicaid.  In addition, Medicaid coverage often continues for a limited time or longer if you no longer qualify for TANF.  See also Medicaid.

Trade Adjustment Assistance (TAA) Program.  A program authorized by the Trade Adjustment Assistance Reform Act of 2002.  This program provides aid to workers who lose their job or whose hours of work and wages are reduced as a result of increased imports.  The TAA Program offers 6 benefits and reemployment services to assist unemployed workers in preparing for and obtaining suitable new employment.  In addition, TAA offers a significant tax credit that covers 65% of health insurance premium for certain plans.

U.S. Department of Labor.  A department of the federal government that regulates employer provided health benefit plans.  You may need to contact the Department of Labor if you are in a self-insured group health plan, or if you have questions about COBRA or the Family and Medical Leave Act.  See also COBRA, Family and Medical Leave Act.

Waiting Period.  The time you may be required to work for an employer before you are eligible for health benefits.  Not all employers require waiting periods.  Waiting periods do not count as gaps in health insurance for purposes of determining whether coverage is continuous.  If your employer requires a waiting period, your pre-existing condition exclusion period begins on the first day of the waiting period.  See also Pre-existing Condition Exclusion Period.