Glossary

Term	Acronym	Definition
Actuarial Value	AV	The Actuarial Value (AV) is the percentage of total average costs for covered benefits that a plan will cover. For example, if your 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 percentage of the total costs of covered services for the year, depending on your actual health care needs and the terms of your insurance policy.
Advance Premium Tax Credit	APTC	An Advance Premium Tax Credit (APTC) is a payment made in advance by the federal government to the insurance company on behalf of the consumer based on their estimated Premium Tax Credit (PTC) for the year to help lower the monthly out-of-pocket premium cost. Consumers must reconcile the amount of APTC they received with their actual PTC eligibility when filing income taxes and either pay back or receive additional tax credits.
Affordability Exemption		An affordability exemption is an exemption to mandatory health coverage based on lack of affordable health coverage, either offered through an employer or through a health care exchange (such as the Federally-facilitated Exchange (FFE)). Coverage is considered unaffordable if costs are more than 8.17% of your projected annual household income in 2024. This exemption allows you to enroll in a Catastrophic health plan.
Affordable Care Act	ACA	The Patient Protection and Affordable Care Act (ACA), also known as the Affordable Care Act, was signed into federal law in March 2010 with the goals of increasing access to affordable health insurance, expanding Medicaid coverage, and supporting innovative methods designed to lower costs. The ACA established Exchanges where individuals and small businesses can shop for and enroll in health insurance plans.
Agent of Record	AOR	An Agent of Record (AOR) is an agent or agency authorized by an insured individual to represent the insured party and manage an insurance policy on their behalf.
American Indian/Alaskan Native	AI/AN	American Indian/Alaskan Native (AI/AN) refers to an individual who identifies as an American Indian or Alaskan Native, and/or is a member of a federally recognized tribe. These individuals are eligible for a zero cost-sharing plan if they purchase a plan through Georgia Access and have an income between 100% and 300% of the Federal Poverty Level (FPL). This means they will not have to pay any out-of-pocket costs, such as deductibles, copayments, and coinsurance when they receive care.
Annual Household Income		The annual household income is the total income for a family in a calendar year.
Appeal (Consumer)		A consumer appeal is a petition by a Georgia Access applicant or enrollee to have any eligibility determination or redetermination reviewed by Georgia Access or the Centers for Medicare & Medicaid Services (CMS). Individuals typically have 90 days to file an appeal of their associated Georgia Access eligibility determination or redetermination.
Appeal (Employer)		An employer appeal is a request that an employer can submit if Georgia Access deemed that the coverage offered to employees does not meet Minimum Essential Coverage (MEC) requirements, or the plan does not meet affordability requirements set by the federal government.
Appeal (Employer Small Business Health Options Program (SHOP))		A Small Business Health Options Program (SHOP) appeal is a request that an employer can submit to have their eligibility determination results reviewed by Georgia Access or the Centers for Medicare & Medicaid Services (CMS).
Binder Payment		A binder payment is the first month’s premium payment a consumer makes to an insurance company to effectuate the health plan they selected. The binder payment covers the cost of the consumer’s first month’s premium and is due based on the insurance company’s binder payment policy (due no sooner than the first day of coverage and no later than 30 days after the first day of coverage). If a consumer does not make the payment by the deadline, their policy will not take effect and they will not be enrolled in coverage. Note: If consumers are in the Open Enrollment Period (OEP) (November 1 to January 15) and have not completed their binder payment, they are still able to change the plan they enroll in.
Catastrophic Health Plan		Catastrophic health plans are high-deductible plans with low premiums that cover Essential Health Benefits (EHBs). Catastrophic health plans generally provide coverage for three (3) primary care visits, preventative services with no cost-sharing, and no other benefits for the Plan Year (PY) until the consumer has incurred cost-sharing expenses in an amount equal to the annual limit. Catastrophic coverage is typically only available to consumers under 30 unless they receive a hardship or affordability exemption.
Center for Consumer Information and Insurance Oversight	CCIIO	The Center for Consumer Information and Insurance Oversight (CCIIO) is the center within the Centers for Medicare & Medicaid Services (CMS) that implements, operates, and oversees provisions of the Patient Protection and Affordable Care Act (ACA) related to Exchanges.
Centers for Medicare & Medicaid Services	CMS	The Centers for Medicare & Medicaid Services (CMS) is the federal agency within the U.S. Department of Health and Human Services (HHS) that is responsible for overseeing Medicaid, the Children’s Health Insurance Plan (CHIP), Medicare, and the individual health insurance market.
Certified Agent		A certified agent is a trained professional who is licensed to sell health insurance products in Georgia. Certified agents must receive Georgia Access certification to sell on Georgia Access. Certified agents can assist consumers with the consumer application and enrollment processes.
Certified Application Counselor Designated Organizations	CDO	A Certified Application Counselor Designated Organization (CDO) is a public or private organization that provides services to underserved consumer populations. Certified CDOs may include hospitals, Federally Qualified Health Centers (FQHCs), health care providers, nonprofit organizations, and state or local government agencies. CDOs apply to participate in Georgia Access to provide health insurance application and enrollment support to Georgia consumers. Certified CDOs enter non-funded business agreements with Georgia Access that grants them the authority to manage Certified Application Counselors (CACs). Certified CDOs are responsible for overseeing the work of individual certified CACs, including training, day-to-day management, and activity monitoring.
Certified Application Counselors	CAC	A Certified Application Counselor (CAC) is an individual who is certified and licensed by the State to support consumers with applying for coverage. Certified CACs are also referred to as assisters. Certified CACs are required to be affiliated with a Certified Application Counselor Designated Organization (CDO), either as an employee or volunteer. Certified CACs provide unbiased support and educate consumers on healthcare options. Like certified Navigators, certified CACs are not permitted to advise consumers on which health plan is best.
Children’s Health Insurance Program	CHIP	Children’s Health Insurance Program (CHIP) is a state-administered program that provides health coverage to eligible children through a combination of Medicaid and state-specific programs, such as Georgia’s PeachCare for Kids®.
Coinsurance		Coinsurance is a percentage of costs for a covered health care service or medication that consumers pay after they have met their deductible. For example, if a plan has 30% coinsurance for x-rays and the deductible has been met, the consumer would pay $30 for a $100 x-ray and the insurance company would pay the rest ($70). The percentage amount varies depending on the level and cost-sharing structure of the plan.
Consolidated Omnibus Budget Reconciliation Act	COBRA	The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees and their families who lose employer coverage as a result of a job loss, reduction in hours, death, or other qualifying events to choose to temporarily keep coverage for a fee. If consumers elect to use COBRA coverage, they pay up to 102% of the premiums, including the share the employer used to pay, plus a small administrative fee.
Copayment		A copayment (commonly referred to as a copay) is a fixed amount ($50, for example) that consumers pay for a covered health care service after they have paid their deductible. Copays vary for different types of services within the same plan like drugs, lab tests, and visits to specialists.
Cost-Sharing Reduction	CSR	A Cost-sharing Reduction (CSR) is a discount that lowers the out-of-pocket maximum consumers pay under the plan for deductibles, copayments, and coinsurance for the Plan Year (PY). Eligible consumers must enroll in a Silver-level plan to receive the discounts. Georgians who identify as an American Indian or Alaskan Native (AI/AN), and/or are a member of a federally recognized tribe are eligible for a zero cost-sharing plan if they purchase a plan through Georgia Access and have an income between 100% and 300% of the Federal Poverty Level (FPL). This means they will not have to pay any out-of-pocket costs, such as deductibles, copayments, and coinsurance when they receive care.
Deductible		A deductible is the amount consumers pay over the course of one calendar year toward covered health care services before the health insurance company begins to pay a percentage of the total bill. Health plans vary on what is counted towards the deductible.
Dependent		A dependent is a child or other individual for whom a consumer financially supports and claims a personal exemption as an annual tax deduction.
Direct Enrollment	DE	Direct Enrollment (DE) is a mechanism by which Qualified Health Plan (QHP) insurance companies and web brokers allow consumers to shop for and enroll directly into plans. This mechanism works either through a double-redirect of the consumer to the Exchange to complete their eligibility application (Classic DE), or via an enrollment platform that offers an end-to-end enrollment experience without requiring a redirect (Enhanced Direct Enrollment).
Disability		A disability is a limited ability in a range of major life activities. This includes, but is not limited to, activities such as seeing, hearing, and walking and on tasks such as thinking and working.
Effective Date of Coverage		The effective date of coverage is the date a consumer’s health insurance coverage begins. It is dependent on both the timing of enrollment and path used. If done through Open Enrollment (OE), it will be the first day of the upcoming Plan Year (PY). In some instances, such as a Special Enrollment Period (SEP), it will be the first day of a future month. For employer-sponsored coverage, it is often the first of the month following a consumer’s enrollment.
Eligibility Determination Notice	EDN	An Eligibility Determination Notice (EDN) is a notice sent to a consumer that details their eligibility determination results for enrollment in health coverage, potentially including Medicaid, Advance Premium Tax Credits (APTCs), and Premium Tax Credits (PTCs).
Enhanced Direct Enrollment	EDE	Enhanced Direct Enrollment (EDE) is a service that private sector partners provide for consumers that allow them to apply for and enroll in plans directly through an approved insurance company or web broker.
Enhanced Direct Enrollment (EDE) Partner		An Enhanced Direct Enrollment (EDE) partner is an organization that is certified to provide a technology platform for consumers to shop for and enroll in Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs). These partners include technology providers, web brokers, and insurance companies. All Georgia Access EDE partners must hold a Federally-facilitated Exchange (FFE) EDE certification.
Essential Health Benefits	EHB	Essential Health Benefits (EHBs) are services that health insurance plans must cover under the Patient Protection and Affordable Care Act (ACA). All insurance plans certified by Georgia Access are required by federal law to include EHBs. These include: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventative and wellness services including chronic disease management; pediatric services, including dental and vision care.
Federal Data Services Hub	FDSH	The Federal Data Services Hub (FDSH) is a tool built and operated by the Centers for Medicare & Medicaid Services (CMS) to verify information to determine eligibility for enrollment in Qualified Health Plans (QHPs) and Premium Tax Credits (PTCs)/Advance Premium Tax Credits (APTCs). Often referred to as “the Hub,” the FDSH provides a single point of access for states to connect to federal data sources to verify immigration, income, citizenship, access to Minimum Essential Coverage (MEC), and other necessary information.
Federal Poverty Level	FPL	The Federal Poverty Level (FPL) is a benchmark published annually by the U.S. Department of Health and Human Services (HHS) that is calculated based on household size. FPL is used to determine a consumer’s eligibility for Premium Tax Credits (PTCs) and Cost-sharing Reductions (CSR), as well as Medicaid and PeachCare for Kids®.
Federally-facilitated Exchange	FFE	The Federally-facilitated Exchange (FFE) is a federal Health Insurance Exchange operated by the Centers for Medicare & Medicaid Services (CMS) pursuant to the Patient Protection and Affordable Care Act (ACA) that enables individual consumers or small business owners to compare and shop for Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs). “FFE” may be used interchangeably with HealthCare.gov or Federally Facilitated Marketplace (FFM).
Flexible Spending Account	FSA	A Flexible Spending Account (FSA), sometimes referred to as a Flexible Spending Arrangement, is a special account pre-tax that consumers can put money into (up to a pre-set limit), then use to pay for certain out-of-pocket health care costs such as deductibles, copayments, and prescriptions. This account is typically set up through the consumer’s employer and is tax-free.
Full-time Equivalent	FTE	Full-time Equivalent (FTE) calculation is used to determine employer size under the Patient Protection and Affordable Care Act (ACA). An employee who works at least 30 hours a week for more than 120 days in a year is considered full time. Part-time employees are defined as working an average of less than 30 hours per week.
Georgia Access Agent Portal		The Georgia Access agent portal is a state-run portal provided free-of-charge to certified agents to maintain their Book of Business (BoB), enroll consumers, and submit tickets to the Georgia Access contact center. All certified agents must establish a profile on the Georgia Access agent portal to receive commissions, regardless of which portal they choose to use for consumer enrollment.
Georgia Access Certification (Certified Agent)		Georgia Access certification refers to the process consisting of completing training modules, passing an exam, and attesting to adhere to all Georgia Access policies and procedures. Certified agents must be certified by the State if they want to sell individual Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) through Georgia Access.
Georgia Access Certification (CAC and Navigator)		Georgia Access certification refers to the process consisting of completing training modules, passing an exam, and attesting to adhere to all Georgia Access policies and procedures. Certified Navigators and Certified Application Counselors (CACs) must be certified by the State in order to help consumers apply for and understand health coverage through Georgia Access.
Georgia Access Consumer Portal		The Georgia Access consumer portal is the state-run online portal that allows consumers to apply for, shop for, and enroll in coverage through Georgia Access. The Georgia Access consumer portal is one of the enrollment options available to consumers in Georgia.
Georgia Access Contact Center		The Georgia Access contact center is the contact center that provides extensive support to consumers, Georgia Access Enhanced Direct Enrollment (EDE) partners, assisters, insurance companies, and certified agents.
Georgia Access Division		The Georgia Access Division is the division of Georgia’s Office of Commissioner of Insurance and Safety Fire (OCI) that operates the Georgia Access State-based Exchange (SBE).
Georgia Access Navigator License		The Georgia Access Navigator license is a type of licensure that individuals must obtain to operate as a certified Navigator in the State of Georgia. Individuals must also obtain certification from the State. The Georgia Access Navigator license is intended to prepare Navigators to utilize the Georgia Access portal and make sure these individuals are trained to provide accurate and adequate assistance to consumers. Navigator Grantees are responsible for validating that their individual Navigators have obtained a Navigator license.
Georgia Access Specialist Licensure		The Georgia Access Specialist License is a type of licensure individuals must obtain to operate as a Certified Application Counselor (CAC) in Georgia prior to receiving certification from their Certified Application Counselor Designated Organization (CDO). The Georgia Access Specialist License prepares CACs to utilize Georgia Access and makes sure that these individuals are properly trained to provide accurate and adequate assistance.
Georgia Access Website		The Georgia Access website is a publicly available website (https://ga-archive.georgiaaccess.gov/) that provides information on Georgia Access programs and services, how to access health insurance, and how to get assistance with applying for coverage.
Hardship Exemption		A hardship exemption is a type of exemption that consumers aged 30 years old and over can apply for if they have experienced a financial hardship or other event that prevented them from getting health coverage. An approved hardship exemption allows a consumer the opportunity to enroll in a Catastrophic health plan.
Health Reimbursement Arrangement	HRA	A Health Reimbursement Arrangement (HRA) is a type of account that an employer funds so that consumers can reimburse themselves for certain medical, dental, or vision expenses. These accounts are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. If a consumer’s funds are not used, they may be rolled over to the next year.
Household		A household (also referred to as “Tax Household”) includes self, spouse if married, and tax dependents — those included on tax returns. This may be different than those actually living in the house. Eligibility for financial income is generally based on the income of all household members, even those who do not need insurance.
Individual Coverage Health Reimbursement Arrangement	ICHRA	An Individual Coverage Health Reimbursement Arrangement (ICHRA), established in 2020, is a type of Health Reimbursement Arrangement (HRA) that allows employers of any size to reimburse employees for some, or all, of their health insurance premiums that employees purchase on their own.
Individual Market		The individual market is where plans are sold to a consumer as an individual, rather than to employers or groups. In the individual market, a Plan Year (PY) spans a calendar year, and consumers are automatically reenrolled for coverage for the next PY unless they choose to enroll in another plan during Open Enrollment (OE) or terminate coverage.
Initial SHOP (Small Business Health Options Program) Enrollment Period		The initial SHOP (Small Business Health Options Program) enrollment period is the initial period of time during which qualified employees enroll in SHOP coverage. This period is determined by the qualified employer and issuer.
In-Network		In-network is defined as the facilities, providers, and suppliers such as doctors, hospitals, and pharmacies that a health insurance company or plan has contracted with to provide health care services. These are commonly referred to as a “provider network” or “preferred providers.”
Insurance Companies		Insurance companies, also known as “issuers” or “carriers,” are licensed by the Office of Commissioner of Insurance and Safety Fire (OCI) to engage in the business of selling, soliciting, or negotiating insurance in Georgia. They are responsible for plan management activities and back-end enrollment and reconciliation activities. Insurance companies may also be certified as Enhanced Direct Enrollment (EDE) partners. For Small Business Health Options Program (SHOP), insurance companies offer SHOP plans, process SHOP applications, and enroll employers in SHOP plans.
Internal Revenue Service	IRS	The Internal Revenue Service (IRS) is the revenue service for the United States federal government, which is responsible for collecting U.S. federal taxes, administering the Internal Revenue Code, and reconciling your estimated premium tax credit.
Change in Circumstance		A life change event, commonly referred to as a Qualifying Life Event (QLE), is an event that makes a consumer eligible to enroll in or change their health insurance coverage outside of the Open Enrollment Period (OEP). Some examples of a life change event include getting married, moving, losing job-based health coverage, or having a child.
Limited English Proficiency	LEP	Limited English Proficiency (LEP) is when someone is not fluent in the English language, often because it is not their native language.  If someone has limited English proficiency, please review the accessibility services offered by Georgia Access.
Medicaid		Medicaid is a joint federal and state health insurance program administered by states, that provides health coverage at little to no cost to people with disabilities, pregnant women, children and families, the elderly, and childless adults whose household income is below a specific level and who meet additional eligibility requirements.
Medicare		Medicare is a federal health insurance program for those 65 and older or who have certain medical conditions. Medicare is not part of the Health Insurance Medicare coverage.
Metal Tiers		Metal tiers are levels used to indicate how much of a medical cost a health insurance plan will cover. Health insurance plans are divided into four tiers named after metals: bronze, silver, gold, and platinum. These levels differ based on how the cost of health care services are split between consumer and insurer. Bronze level plans have the lowest monthly premium but highest costs for care while platinum plans have the highest monthly premiums but lowest costs for care. The levels have no impact on the quality of care consumers receive. Consumers must be enrolled in a Silver plan to be eligible for Cost-sharing Reductions (CSRs).
Minimum Essential Coverage	MEC	Minimum essential coverage (MEC), sometimes referred to as “qualifying health coverage,” is any type of insurance plan that meets the Affordable Care Act (ACA) requirement for having health coverage. Consumers must be enrolled in a plan that qualifies as MEC. Examples of plans that qualify include Marketplace plans, job-based plans, Medicare, Medicaid, and PeachCare for Kids®.
Minimum Participation Rate	MPR	The Minimum Participation Rate (MPR) is calculated as the number of qualified employees who accept coverage under an employer’s group health plan, divided by the number of qualified employees offered coverage. The MPR to qualify for the Georgia Access Small Business Health Options Program (SHOP) coverage is 70% of qualified employees who are offered insurance, not including employees with other health coverage.
Modified Adjusted Gross Income	MAGI	Modified Adjusted Gross Income (MAGI) is a consumer’s Adjusted Gross Income (AGI) after taking into account allowable deductions and tax penalties. This adjusted income is used to calculate their eligibility for Premium Tax Credits (PTCs), Advance Premium Tax Credits (APTCs) and other health plan savings.
National Association of Insurance Commissioners	NAIC	The National Association of Insurance Commissioners (NAIC) is a nonprofit, nonpartisan organization governed by the chief insurance regulators of the 50 states, the District of Columbia (D.C.), and the five U.S. territories. NAIC sets standards and establishes best practices for the U.S. insurance industry and provides support to insurance regulators. NAIC also owns and operates the System for Electronic Rates & Forms Filing (SERFF).
National Insurance Producer Registry	NIPR	The National Insurance Producer Registry (NIPR) maintains a database known as the Producer Database (PDB), which contains information about certified agents and brokers (also known as producers) provided by state Departments of Insurance (DOI). The NIPR contains data on National Producer Numbers (NPNs), Lines of Authority (LOA), and state licensure. The State of Georgia uses NIPR to manage all certified agent license applications, approvals, renewals, and maintenance.
National Producer Number	NPN	A National Producer Number (NPN) is a unique identification number that is assigned to certified agents and web brokers by the National Association of Insurance Commissioners (NAIC). A NPN tracks individuals and ensures compliance with state licensing requirements.
Navigator Grantees		Navigator Grantees are organizations or a consortium of organizations that apply for and receive grants funded by Georgia Access to provide health insurance application support to Georgia consumers. Navigator Grantees oversee the work of individual certified Navigators, including training, day-to-day management, and activity monitoring. Additionally, Navigator Grantees are required to conduct a minimum of three outreach, education, and enrollment events concerning health insurance coverage opportunities for consumers per reporting period.
Navigators		A certified Navigator is an individual who is certified and licensed by the State to support consumers with applying for health coverage. Certified Navigators are also referred to as assisters. Certified Navigators are affiliated with a Navigator Grantee Organization, either as employees or volunteers. Certified Navigators are grant-funded and provide outreach and education to all consumers, including underserved or vulnerable populations. Certified Navigators are not permitted to advise consumers on which health plan is best.
National Insurance Producer Registry	NIPR	The National Insurance Producer Registry (NIPR) maintains a database known as the Producer Database (PDB), which contains information about insurance agents and brokers (also known as producers) provided by state Departments of Insurance (DOI). The NIPR contains data on National Producer Numbers (NPNs), Lines of Authority (LOA), and state licensure.
Office of Commissioner of Insurance and Safety Fire	OCI	The Office of Commissioner of Insurance and Safety Fire (OCI) is an agency that licenses and regulates insurance companies, investigates reports of insurance fraud in Georgia, and provides consumers services including insurance financial oversight, insurance product review, certified agent licensing, insurance enforcement, and fraud investigation.
Open Enrollment Period	OE	Open Enrollment (OE), also known as an Open Enrollment Period (OEP), is the annual period when consumers may enroll in an individual health insurance plan for the upcoming Plan Year (PY). OE typically starts on November 1 of each year for coverage beginning on January 1 of the following year.
Out-of-Pocket Costs		Out-of-pocket costs are expenses for medical care that are not reimbursed by insurance. These typically include deductibles, coinsurance, and copayments for covered services.
PeachCare for Kids®		PeachCare for Kids® is the State Children Health Insurance Program (S-CHIP) that covers uninsured children across Georgia. This program provides comprehensive health benefits including primary, preventative, specialist, dental, and vision care at little to no cost to qualifying families. To be eligible for PeachCare for Kids, households must meet certain criteria, including specific income requirements.
Personally Identifiable Information	PII	Personally Identifiable Information (PII) is any information that can be used to identify consumers by direct or indirect means.
Plan Year	PY	A Plan Year (PY) is the 12-month period of time during which the health insurance plan is effective (January 1 – December 31 for the individual market). While the PY always follows the calendar year for the individual market, coverage provided may be shorter if consumers enroll mid-year.
Premium		A premium is the amount consumers are required to pay to the health insurance company each month in order to maintain coverage.
Premium Tax Credit	PTC	A Premium Tax Credit (PTC) is a federal income tax credit for eligible consumers enrolled in a Qualified Health Plan (QHP). The tax credit is based on the consumer’s income at tax filing, the associated affordability threshold set by the Internal Revenue Service (IRS), and the cost of the Second Lowest-cost Silver Plan (SLCSP) in the consumer’s county.
Projected Annual Income	PAI	Projected Annual Income (PAI) is an estimate of a consumer’s expected household income for a year. It is used to make determinations of financial eligibility for a variety of health plans and benefits. For example, to receive approval for a Premium Tax Credit (PTC) or a Cost-sharing Reduction (CSR), consumers need to provide PAIs that fall within the eligibility parameters of each respective benefit.
Public Awareness Campaign	PAC	The Georgia Access Public Awareness Campaign (PAC) is designed to increase awareness of coverage options through Georgia Access using a research-driven marketing approach focused on targeting current consumers and the uninsured population in Georgia.
Public Use File	PUF	Public Use Files (PUFs) are downloadable files posted publicly with plan- and issuer-level information for Qualified Health Plans (QHPs) and Stand-alone Dental Plans (SADPs) offered on the Exchange, including data such as benefits and cost sharing data, service areas, rates, and Quality Rating System (QRS) star ratings.
Qualified Employee		A qualified employee is an individual employed by a qualified employer who has been offered health insurance coverage by the small business qualified employer.
Qualified Employer		A qualified employer is a small business employer that is determined eligible to enroll in Small Business Health Options Program (SHOP) plans or provide SHOP plans to employees.
Qualified Health Plan	QHP	Qualified Health Plans (QHPs) are individual market plans that are certified to be sold on the Exchange. They follow state and federal requirements as established under the Affordable Care Act (ACA) for plan benefits, cost-sharing, and network adequacy.
Qualified Small Employer Health Reimbursement Arrangement	QSEHRA	A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is a type of Health Reimbursement Arrangement (HRA) that allows small employers (50 or fewer employees) who do not offer group health insurance to their employees, to contribute up to the Internal Revenue Service (IRS) limit toward their employees’ qualified medical expenses.
Qualifying Life Event	QLE	“A Qualifying Life Event (QLE), also referred to as a life change event, is a change in a consumer’s situation, such as getting married, having a baby, or losing health coverage, that can make a consumer eligible for a Special Enrollment Period (SEP), allowing a consumer to enroll in health insurance outside the yearly Open Enrollment Period (OEP).
Recission		A recission is a retroactive cancellation of a health insurance policy. Under federal law, recission is illegal except in cases of fraud or intentional misrepresentation of facts as prohibited by the terms of the plan or coverage.
Second-lowest Cost Silver Plan	SLCSP	The Second-lowest Cost Silver Plan (SLCSP), also known as the benchmark plan, is the second-lowest priced health insurance plan in the Silver category that applies to each individual consumer. It may not be the plan consumers are enrolled in, but consumers must know the SLCSP premium for the Exchange to determine their final Premium Tax Credit (PTC). In most cases, consumers can find their SLCSP premium on Form 1095-A.
Sircon		Sircon is a licensing product and system used by multiple states, including the State of Georgia, to manage all license applications, approvals, renewals, and maintenance
Small Business Employer		A small business employer refers to a qualified employer that has 50 or fewer full-time equivalent (FTE) employees in the State of Georgia.
Small Business Health Care Tax Credit		The Small Business Health Care Tax Credit is a federal tax credit that may be available to employers with fewer than 25 employees who pay at least 50 percent of health insurance premiums on behalf of employees enrolled in Qualified Health Plans (QHPs) through the Georgia Access Small Business Health Options Program (SHOP).
Small Business Health Options Program (SHOP)	SHOP	The Small Business Health Options Program (SHOP) was established by the Affordable Care Act (ACA) to provide quality, affordable health insurance for small employers and their employees. Unlike the individual market, there is no annual Open Enrollment (OE) for SHOP coverage. Employers may apply for SHOP any time beginning November 1 for coverage beginning the following year.
Small Business Health Options Program (SHOP) Eligibility Period		A Small Business Health Options Program (SHOP) eligibility period is a 12-month period, starting on the date of the SHOP Eligibility Determination Notice (EDN), during which a qualified employer is eligible to enroll in SHOP coverage with a certified agent or insurance company.
Small Business Health Care Tax Credit		The Small Business Health Care Tax Credit is a federal tax credit that may be available to employers with fewer than 25 employees who pay at least 50 percent of health insurance premiums on behalf of employees enrolled in qualified health plans (QHPs) through Georgia Access Small Business Health Options Program (SHOP).
Small Business Employer		A small business employer in Georgia refers to qualified employers with 50 or fewer full-time equivalent (FTE) employees.
Special Enrollment Period	SEP	A Special Enrollment Period (SEP) is a time outside of Open Enrollment Period (OE) when you can sign up for health insurance if you experience a Qualifying Life Event (QLE). You can qualify for an SEP if you’ve experienced certain life events such as moving, getting married, having a child, or losing your job-based coverage.
Stand-Alone Dental Plan	SADP	Stand-alone Dental Plans (SADPs) are a type of dental plan offered on-Exchange that only includes insurance coverage for dental benefits. Consumers typically select these plans if dental benefits are not included within their Qualified Health Plan (QHP).
State-based Exchange	SBE	A State-based Exchange (SBE) is an online marketplace (sometimes referred to as “Exchange”) fully operated by a state where consumers can shop for, apply for, select, and enroll in health insurance plans.
State-based Exchange on the Federal Platform	SBE-FP	A State-based Exchange on the Federal Platform (SBE-FP) is an online marketplace that allows a state to take on some Exchange functions but is supported by the Federal Platform (FP) for eligibility and enrollment and other necessary functions. Georgia Access operated as an SBE-FP for Plan Year (PY) 2024.
Summary of Benefits and Coverage	SBC	A Summary of Benefits and Coverage (SBC) is a standardized form that summarizes the benefits and coverage available for each health plan to help consumers compare different plans.
Temporary Assistance for Needy Families	TANF	Temporary Assistance for Needy Families (TANF) is the monthly cash assistance program, with an employment services component, for low-income families with children under age 18, children age 18 and attending school full-time, and pregnant woman.
U.S. Department of Health and Human Services	HHS	The U.S. Department of Health and Human Services (HHS) is the federal cabinet-level agency that oversees the legal authority of the Centers for Medicare & Medicaid Services (CMS).
Web Broker		Web brokers are Enhanced Direct Enrollment (EDE) partners that facilitate consumer direct enrollment in Qualified Health Plans (QHPs) and/or Stand-alone Dental Plans (SADPs) via a technology platform. Web brokers display plans across all insurance companies participating in Georgia Access. To be considered a web broker for Georgia Access, an entity must hold Federally-facilitated Exchange (FFE) EDE and Georgia Access EDE certification. Web brokers that own and operate their underlying technology platform are also considered technology providers.