Glossary: HIPAA

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The minimum number of hours per week that an employee is required to work to qualify for and maintain eligibility for benefits.

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A trained expert who can help you understand and apply for benefit programs. Their goal is to help you develop a plan for your future and organize your financial life to run as smoothly as possible.

  • For questions about work and your Social Security benefits, use Social Security's "Find Help" tool to locate a WIPA project near you. You can also call the Ticket to Work Help Line at 1-866-968-7842 / 1-866-833-2967 (TTY/TDD). The Department of Rehabilitation (DOR) also has Work Incentives Planners (WIPs).
  • If you need assistance with your Medicare, the Health Insurance Counseling & Advocacy Program can help. HICAP provides free information and counseling to people with Medicare. You can call HICAP at 1-800-434-0222 or visit the HICAP website.
  • If you need assistance with Medi-Cal and have a disability, you can contact Disability Rights California at 1-800-776-5746 or visit their website. You may also be able to get help with Medi-Cal from a local legal aid organization. The Health Consumer Alliance website has a lot of useful information about Medi-Cal, including a web page that can direct you to a local legal organization for assistance.
  • If you have questions or need assistance with a program or benefit not listed here, contact an Independent Living Center. Independent Living Centers provide peer support and information on a wide range of topics for people with disabilities.
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The date an individual is enrolled in coverage. The effective date is usually not the same as the date of hire.

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A person, usually a child, who is economically dependent on another person. Different programs have different definitions of when someone is a dependent.

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Salaries, wages, tips, professional fees, and other amounts you receive as pay for physical or mental work you perform. This can include things you get in exchange for work instead of wages, such as food, shelter, or other items. Funds received from any other source are not included. (Contrast: unearned income.)

Health coverage offered through an employer as a benefit for employees and their families. Employers usually pay a portion of the monthly premium and the employee pays the rest.

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Coverage offered to an individual through a group, such as employer-sponsored, association-affiliated or professional group coverage.

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A law that protects the privacy and confidentiality of your health information, such as medical records and test results. It regulates how health care providers are allowed to handle and share your protected health information.

HIPAA also prevents group health plans from denying you coverage based on your health condition and provides protections for those buying individual health coverage. However, these parts of HIPAA are protections that are no longer needed, since the Affordable Care Act provides all the same protections, plus more.

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Wage-replacement coverage you buy directly from an insurance company, usually through an agent, that provides benefits if you become disabled. You are responsible for paying for the entire premium, and most individual policies require medical underwriting.

The first time an individual is eligible to enroll in a group’s benefits programs.

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Any medical care that you receive for a medical condition. Some examples include being prescribed medication, visits to the doctor, and therapy for a mental health problem.

The review of an individual’s medical history and/or medical records to determine if the individual is eligible for coverage. Medical underwriting, which may include new medical testing, can be used to deny coverage or determine if a particular pre-existing condition will be covered.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

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The annual time period when an individual may add or change private insurance plans offered by an employer, an association, or through Covered California. Certain situations, such as divorce, the birth of a child, or loss of another insurance plan may allow a person to sign up for an insurance plan outside of this time period.

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Any condition for which “medical care” was received within six months prior to the effective date of insurance coverage. Medical care includes the use of prescription drugs and physician consultations and services. During a pre-existing condition exclusionary period, coverage for that condition is either not provided or can be limited.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

The period of time from the coverage effective date that the insurer does not cover a pre-existing medical condition. The individual will normally be covered for the condition once the specified time has elapsed.

The Affordable Care Act prohibits health insurance companies from doing medical underwriting and excluding pre-existing conditions from coverage. Other forms of insurance, like private disability insurance, can do medical underwriting and exclude pre-existing conditions.

A regularly scheduled payment to an insurer or health care plan.

Health coverage through a private company that pays for medical expenses. A monthly premium must be paid for this coverage by the individual or family covered, by an employer, or by an association. The individuals covered by private health plans must also make payments such as copayments or coinsurance each time they use certain medical services.

In some cases, the federal government may help low to middle-income families pay for private health coverage through tax subsidies if they are in very specific situations and do not have other affordable health coverage alternatives.

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The Uniformed Services Employment and Reemployment Rights Act (USERRA) is a federal law that protects veterans’ and service members’ employment rights. It says that a person can miss up to five years of work because of military duty and have the right to be re-employed by the employer they had before going on duty. It also requires employers to make reasonable accommodations for disabled veterans.