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Third Party Administrator (TPA)

An organization that processes insurance claims and/or handles certain aspects of employee benefit plans for another business.

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Tax Credit

A tax credit, or Advance Premium Tax Credit (APTC), can reduce what you pay for health insurance. When you apply for coverage through Maryland Health Connection, you’ll estimate your household income to find out if you qualify for an advance payment of the premium tax credit that lowers your premium …

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Summary of Benefits and Coverage

You will receive a Summary of Benefits and Coverage when you enroll in your health plan. It describes the benefits and costs associated with your plan.

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Subsidy

Cost-sharing subsidies will reduce the amount of health care expenses you have to pay when you get health care. Some Marylanders with lower incomes will qualify for tax credits to reduce their premium and cost-sharing subsidies to help with out-of-pocket costs such as copayments or coinsurance.

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Stand-Alone Coverage

Some plans already include dental as part of their basic plans. If the plan you select does not include this, you have the option of buying dental coverage separately. This is called “stand-alone” dental insurance.

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Specialist

A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions. A non-physician specialist is a provider who has more training in a specific area of health care.

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Skilled Nursing Care

Services from licensed nurses in your own home or in a nursing home. Skilled care services are from technicians and therapists in your own home or in a nursing home.  

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Small Business Health Options Program (SHOP)

The SHOP is a program of Maryland Health Connection, the new online health insurance marketplace. The SHOP enables small businesses and their employees to compare and shop for qualified health plans (QHPs). The SHOP is the only place where Maryland’s small businesses can get federal tax credits to lower their …

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Rehabilitation Services

Health care services that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled. These services may include physical and occupational therapy, speech-language pathology and psychiatric rehabilitation services in a variety of …

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Reconstructive Surgery

Surgery and follow-up treatment needed to correct or improve a part of the body because of birth defects, accidents, injuries or medical conditions.

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