Glossary

A collection of terms and their definitions

A

allowance: The amount an employer makes available to help employees pay for coverage or eligible expenses.
Related terms: Premium, Qualified medical expense

CHOICE Arrangement: Another name for an ICHRA. Thatch documentation uses ICHRA, but you may see the same benefit called a CHOICE Arrangement elsewhere.
Related terms: Individual Coverage Health Reimbursement Arrangement, Health Reimbursement Arrangement, Allowance
COBRA (Consolidated Omnibus Budget Reconciliation Act): A federal law that allows employees to temporarily continue employer-sponsored health insurance after leaving a job, reducing work hours, or experiencing other qualifying events. Employees typically pay the full premium cost plus an administrative fee.
Related terms: Premium, Qualifying Life Event
coinsurance: The percentage of costs a patient pays for a covered service after they have met their deductible.
Related terms: Deductible, Out-of-pocket maximum
covered services: Healthcare services and treatments that the insurance plan helps pay for, as defined in the plan documents.
Related terms: Qualified medical expense, Coinsurance

deductible: The amount a patient pays out of pocket for covered services before the insurance plan begins to pay.
Related terms: Out-of-pocket maximum, Coinsurance

Exclusive Provider Organization (EPO): A plan type that covers services only from in-network providers, except in emergencies. EPOs do not require referrals to see specialists.
Related terms: Health Maintenance Organization, Point of Service, Preferred Provider Organization, In-network

Health Maintenance Organization (HMO): A plan type that limits coverage to providers in its network and typically requires patients to choose a primary care physician and get referrals to see specialists.
Related terms: Exclusive Provider Organization, Point of Service, Preferred Provider Organization, In-network
Health Reimbursement Arrangement (HRA): An employer-funded account that reimburses employees for qualified medical expense and, in some cases, insurance premiums. Unlike an HSA, HRA funds belong to the employer.
Related terms: Health Savings Account, Qualified medical expense, Premium
Health Savings Account (HSA): A tax-advantaged savings account for individuals enrolled in a high-deductible health plan (HDHP). The employee own the funds, funds roll over year to year, and funds can be used for qualified medical expense.
Related terms: Health Reimbursement Arrangement, Deductible, Qualified medical expense

in-network: A provider that has a contract with the patient's insurance plan. Visiting in-network providers typically costs less than going out-of-network.
Related terms: Out-of-network, insurance company
Individual Coverage Health Reimbursement Arrangement (ICHRA): An employer-funded arrangement that reimburses employees tax-free for individual health insurance premiums and qualified medical expenses, instead of the employer offering a group health plan. Also called a CHOICE Arrangement.
Related terms: CHOICE Arrangement, Health Reimbursement Arrangement, Allowance, Qualified medical expense
Individual Taxpayer Identification Number (ITIN): A tax processing number issued by the IRS to individuals who are not eligible for a Social Security Number (SSN). ITINs are used for federal tax reporting purposes and may be accepted in place of an SSN when enrolling in certain health insurance plans.
insurance company: The company that provides insurance coverage. Also called an insurance provider.
Related terms: In-network, Out-of-network

metal tiers: Categories of health insurance plans—Bronze, Silver, Gold, and Platinum—that indicate how costs are shared between the patient and the insurance company. Bronze plans have lower premiums but higher out-of-pocket costs; platinum plans have higher premiums but lower out-of-pocket costs.
Related terms: Premium, Deductible, Out-of-pocket maximum

Open Enrollment Period (OEP): A defined window when employees can make coverage choices without a qualifying event.
Related terms: Qualifying Life Event
out-of-network: A provider that does not have a contract with the patient's insurance plan. Out-of-network care usually costs more and may not be covered at all by some plan types.
Related terms: In-network, insurance company
out-of-pocket maximum: The most a patient has to pay for covered services in a plan year. After a patient reaches this amount, the plan pays 100% of covered services.
Related terms: Deductible, Coinsurance

Personally Identifiable Information (PII): Any data that could be used to identify a specific individual, such as their name, date of birth, address, or Social Security number. Thatch collects PII to verify identities and administer benefits.
Point of Service (POS): A plan type that combines features of HMO and PPO plans. Patients need a referral from their primary care physician to see a specialist, but can go out-of-network at a higher cost.
Related terms: Exclusive Provider Organization, Health Maintenance Organization, Preferred Provider Organization, In-network, Out-of-network
Preferred Provider Organization (PPO): A plan type that offers a network of providers but also covers out-of-network care at a higher cost. No referrals are needed to see specialists.
Related terms: Exclusive Provider Organization, Health Maintenance Organization, Point of Service, In-network, Out-of-network
premium: The monthly amount paid to maintain health insurance coverage, regardless of whether any services are used that month.
Related terms: Allowance, Metal tiers

qualified medical expense (QME): A type of healthcare cost that counts as eligible for specific plans or accounts.
Related terms: Covered services
qualifying life event (QLE): A change in life—such as marriage, birth, or loss of other coverage—that may allow employees to change benefits mid-year.
Related terms: Open Enrollment Period

Special Enrollment Period (SEP): A time outside the yearly Open Enrollment Period when employees can sign up for health insurance. A SEP is triggered by a qualifying event such as losing health coverage or getting married.
Related terms: Open Enrollment Period