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Plan Type

The types of health insurance plans offered through Maryland Health Connection are Health Maintenance Organizations (HMOs), Preferred Provider Organization (PPO), Point-of-Service (POS), Exclusive Provider Organization (EPO), Integrated Delivery System (IDS), and HSA-eligible plans. (If you are enrolled in Medicaid, MCHP or MCHP Premium, you will choose a managed care organization to …

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Plan Level

Health insurance plans offered on Maryland Health Connection are categorized into four metal Levels: bronze, silver, gold, and platinum. The metal level represents the average portion of your medical expenses an insurance plan is expected to pay. This is commonly referred to as the “actuarial value” of the plan.

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Modified Adjusted Gross Income (MAGI)

The figure used to determine eligibility for lower costs through Maryland Health Connection, including private (qualified) health plans, Medicaid and the Maryland Children’s Health Program (MCHP). Generally, modified adjusted gross income is your adjusted gross income plus any tax-exempt Social Security, interest, or foreign income you have. Use our calculator …

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Special Enrollment Period

A time outside of the open enrollment period during which you and your family may have a right to sign up for health coverage. You qualify for a special enrollment period through Maryland Health Connection for 60 days after certain life events that involve a change in family status (for …

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Qualifying Life Event

A change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage. Examples of qualifying life events are changes in your family size (for example, if you marry, divorce, or have a baby), certain changes in your income, or losing your current …

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Maryland Children’s Health Program (MCHP)

Maryland Children’s Health Program (MCHP) is a program that provides medical coverage for qualifying uninsured children under the age of 19. Uninsured children from households with higher income levels may qualify for MCHP Premium. A small premium is required to enroll in MCHP Premium. Unlike traditional health insurance, premiums for …

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Actuarial Value

The percentage of total average costs for covered benefits that a plan will cover. For example, if a plan has an actuarial value of 70%, on average, you would be responsible for 30% of the costs of all covered benefits. However, you could be responsible for a higher or lower …

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Urgent Care

Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.

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Uninsured

If you do not currently have health insurance, you are uninsured.

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UCR (Usual, Customary and Reasonable)

The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.  

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