1.  Health Maintenance Organization (HMO) - ​With this network you chose one primary care
                                                             physician through which all your health care services are directed, therefore                                                                you need a referral before seeing another health care professional.  Visits to
                                                             physicians outside the network are not covered unless there is an emergency.
                                                            (Exception:  you do not need a referral to see an obstutrition)
Network - The hostpitals, physicians, laboratories and other healthcare professionals or facilities selected to conrtact
                   with the insurance companies for participation in the health plan.
Copayment - The amount of money you pay each time you receive medical services, usually a set dollar amount.
Deductible - The set dollar amount that you must pay, if applicable, for services covered by your health plan during
                       each benefit period before the insurance company begins making payments

Special triggering events


If you find yourself in one of the following personal or family circumstances, you are able to get an ACA plan outside the Open Enrollment period without penalty:


  1.  Losing Minimum Essential Health Coverage;

  • Losing Job
  • Employer coverage terminated

  2.  Getting Married

  3.  Divorce

  4.  Relocating

  5.  New Child

  • Birth
  • Adoption

  6.  Change in Income

  • Cost is more than 9.5% of income

  7.  Losing or Gaining Medicaid or CHIP Eligibility

  8.  Cobra Expiration

  9.  Health Plan Decertified

  • No longer offered in area
  • Plan is no longer offered


This is a partial list.  Check CMS.Gov for complete list.


           


Health Terms and Explanations

4.  Health Savings Account  (HSA) -.A tax-advantaged account created by people with high

                                          deductible health insurance plans where funds are set aside for medical

                                          expenses not paid by the health plan.  Contributions are limited per year,

                                          those not spent roll over to the next year, and they are only tax favorable

                                          if used for medical expenses.

3.  Exlusive Provider Organization  (EPO) - This network combines many of the best benefits of

​                                          HMO and the PPO.  Like the PPO plan you don't have to name a primary

                                          care physician and you don't need a referral to see a specialist.  But, like                                             the HMO plan you have a limited network of doctors and facilities, and you                                           will pay all costs for services outside of the network.     

For Additional Information or Explanation Please Feel Free to Contact Us - Click the button to request additional information, explantion or to request changes you would like to see to the web site!  We would appreciate your input!

LYnky Insurance  Benefits

Formulary - The list of prescription drugs covered by the insuring company for each plan they offer.
                2.  Preferred Provider Organization (PPO) - This network allows you to go to any health care                                                                            professional without a referral, in or out of the network.  However, staying  
                                                             outside the network​, unless there is an emergency, means higher out-of-
                                                             pocket costs, and more benefits.  Networks are generally much larger.
​                                                             
Coinsurance - The percentage of the cost you pay for covered medical services after you have met your deductible or
​                         paid your copayment.

proposed changes under the

new  american health care act​ 

  1.  No longer required to purchase health care. 

       a.)  ​ Eliminates tax penalty.

  2.  Insurers may charge a 30% up charge for one

         year on those with preexisting conditions unless

         present plan is maintained and there is less than

         a 63 day lapse in insurance coverage.

​  3.  Elimination of the income-base tax credits and 

​         subsidies.

       a.)   Replaced by age based tax credits.

              1.)  Ranging from $2000 for a 20 year old to

                      $4000 for a 60 year old.

​  4.  Eliminates nearly all taxes issued under the 

         Affordable Care Act to pay for the subsidies.

       a.)  Projections indicate annual fluctuation of 

              younger adults up and down, but a significant 

              increase everywhere for older adults!

  5.  Cuts to Medicaid funding for healthy adults who 

         leave the low income roll

       a.)  Cut to Medicaid spending of projected $880 

​               billion.