Glossary of Terms

Health Insurance Terms for Medicaid & CHIP

CHRISTUS Health Plan wants to help you understand the basics of Medicaid insurance and CHIP plans. You can find definitions for health insurance terms here. If you still have questions or would rather talk with someone, contact us or call 1-844-282-3100 to connect with our member services team. We’re here to help.

Affordable Care Act (ACA): a law passed in 2010 to offer more health insurance options, discounts and broader Medicaid coverage. Also known as Obamacare.

Appeal: a request asking your health plan to review a ruling on coverage or payment. Learn more about appeals and grievances.

Brand Name Drug: a drug sold under a specific, trademarked brand name.

Children’s Health Insurance Program (CHIP): insurance coverage for children in low-income households or pregnant women who don’t qualify for Medicaid but can’t afford insurance.

Claim: a request for payment from your health insurance provider for services, procedures or a drug.

Coinsurance: how health care costs are split with your insurance after your deductible is met.

Copayment: what you pay for a service when you receive it, like a doctor’s office visit or getting a prescription filled.

Deductible: the amount you must pay before your health insurance kicks in.

Dependent: a child or other person who is claimed by another for a personal tax exemption.

Formulary: a list of generic and brand name drugs chosen and covered by a health insurance plan.

Generic Drug: a drug with the same ingredients as a brand name drug but without the trademarked name. Generic drugs are usually covered by a health plan instead of brand name ones.

Medicaid: a health insurance program that assists low-income families, the elderly and people with disabilities.

Premium: a monthly, quarterly or annual amount you pay for health insurance coverage.

Primary Care Provider: the doctor or nurse practitioner that is your main provider of health services.

STAR: State of Texas Access Reform (STAR) is the program that provides primary, acute care and pharmacy services for low-income families, children, pregnant women and some former foster care youth. The program operates statewide with services delivered through 18 health plans contracted with the Health and Human Services Commission (HHSC) including CHRISTUS Health Plan.

Last updated: 2/23/17