A Plain-English Guide by Suncoast Health & Life

Health insurance is filled with acronyms—and most people are never taught what they actually mean. This glossary helps individuals, families, and small business owners understand the language used in ACA Marketplace plans, private health insurance, life insurance policies, employer coverage, Medicare, and compliance conversations. 

Understanding these terms helps you:

• avoid costly enrollment mistakes
• choose coverage aligned with your health and budget
• navigate ACA, private, employer, and Medicare options confidently

At Suncoast Health & Life, the goal isn’t just coverage—it’s clarity. 

Whether you’re reviewing plan options, enrolling during Open Enrollment, or just trying to decode paperwork, this guide is here to help. 

Federal law that created the Health Insurance Marketplace and established consumer protections and income-based subsidies.

Why this matters

• Prospective policyholders:
  Determines whether you can enroll in ACA plans, qualify for premium subsidies (APTC), receive cost-sharing reductions (CSR), and obtain coverage regardless of pre-existing conditions.
   
• Current policyholders:
  Governs how your plan works, when and how you can make changes, how subsidies adjust with income changes, and what protections apply to your coverage.
   
• Agents/brokers:
  Forms the core regulatory framework for Marketplace enrollment, servicing, subsidy accuracy, documentation, and compliance.
   

Basic self-care activities such as bathing, dressing, eating, and mobility.

Why this matters

• Prospective policyholders:
  ADLs often determine eligibility or benefit triggers for disability insurance, long-term care, and certain supplemental policies.
   
• Current policyholders:
  Loss of one or more ADLs may activate benefits or claims under disability or long-term care coverage.
   
• Agents/brokers:
  Helps identify risk exposures that traditional medical insurance does not address.
   

Rules and regulations designed to prevent financial crimes and illicit activity.

Why this matters

• Prospective policyholders:
  Identity verification or additional documentation may be required during enrollment.
   
• Current policyholders:
  Ongoing monitoring may occur when changes or financial transactions are made.
   
• Agents/brokers:
  Mandatory compliance responsibility with strict penalties for non-compliance.
   

The licensed insurance agent officially assigned to service and manage a policy.

Why this matters

• Prospective policyholders:
  Determines who is authorized to guide you through enrollment and plan selection.
   
• Current policyholders:
  Controls who can make changes, assist with claims questions, and provide ongoing service.
   
• Agents/brokers:
  Protects client relationships and ensures proper authority to act on a policyholder’s behalf.
   

Technology that allows different software systems to communicate with one another.

Why this matters

• Prospective policyholders:
  Affects how smoothly applications, enrollments, and data transfers occur.
   
• Current policyholders:
  Impacts accuracy and speed of updates, renewals, and data synchronization.
   
• Agents/brokers:
  Enables enrollment platforms, quoting tools, and Marketplace integrations.
   

An ACA subsidy that lowers monthly Marketplace premiums based on household income.

Why this matters

• Prospective policyholders:
  Can make health insurance affordable when it otherwise wouldn’t be.
   
• Current policyholders:
  Income changes can increase, reduce, or eliminate the subsidy and may impact tax filings.
   
• Agents/brokers:
  Accurate income guidance is critical to prevent subsidy clawbacks and reconciliation issues.
   

The percentage of medical costs a health plan is expected to cover on average.

Why this matters

• Prospective policyholders:
  Lower premiums often come with higher deductibles and out-of-pocket exposure.
   
• Current policyholders:
  Helps explain why costs feel higher or lower when care is used.
   
• Agents/brokers:
  Key tool for matching plan design to a client’s financial and medical risk tolerance.

The ACA process that automatically renews a policyholder into a similar plan for the next plan year.

Why this matters

• Prospective policyholders:
  If you don’t actively shop during Open Enrollment, you may be automatically placed into a plan that is no longer the best fit or value.
   
• Current policyholders:
  Premiums, deductibles, networks, and subsidies can change year to year—even if you’re auto-renewed.
   
• Agents/brokers:
  Annual reviews are critical to prevent clients from being passively renewed into suboptimal plans.
   

A state-level health coverage program available in some states for individuals within certain income ranges.

Why this matters

• Prospective policyholders:
  In participating states, a BHP may offer lower-cost coverage than standard ACA plans.
   
• Current policyholders:
  Eligibility changes can move you between a BHP and the ACA Marketplace.
   
• Agents/brokers:
  Requires state-specific knowledge and awareness of limited availability.
   

Information identifying individuals who own or control certain business entities.

Why this matters

• Prospective policyholders:
  Business owners may be required to disclose ownership details during enrollment or compliance reviews.
   
• Current policyholders:
  Changes in business ownership may trigger reporting or documentation requirements.
   
• Agents/brokers:
  Important for business-related policies and regulatory compliance under transparency laws.
   

A U.S. federal law requiring financial institutions to assist government agencies in detecting and preventing financial crimes.

Why this matters

• Prospective policyholders:
  Identity verification and financial checks may be part of the enrollment process.
   
• Current policyholders:
  Certain transactions or changes may require additional scrutiny.
   
• Agents/brokers:
  Establishes mandatory reporting and recordkeeping responsibilities tied to compliance.

A division of the U.S. Department of Health and Human Services responsible for implementing and overseeing ACA insurance market reforms.

Why this matters

• Prospective policyholders:
  CCIIO helps ensure ACA plans meet consumer protection standards and marketplace rules.
   
• Current policyholders:
  Oversees carrier compliance, appeals processes, and marketplace operations affecting your coverage.
   
• Agents/brokers:
  Sets operational guidance, policy updates, and compliance expectations for Marketplace enrollment.
   

The process of verifying a consumer’s identity and assessing risk during enrollment or financial transactions.

Why this matters

• Prospective policyholders:
  You may be asked to provide documentation to verify identity or eligibility before coverage is finalized.
   
• Current policyholders:
  Certain changes or updates may trigger additional verification.
   
• Agents/brokers:
  Required compliance step to prevent fraud and ensure lawful enrollment.
   

An internal system used to track compliance controls and operational oversight.

Why this matters

• Prospective policyholders:
  Generally invisible to consumers but supports system integrity.
   
• Current policyholders:
  Helps ensure enrollment actions and changes are properly documented.
   
• Agents/brokers:
  Used to demonstrate adherence to regulatory and operational requirements.
   

Rules and controls designed to prevent funds from being used to support terrorist activities.

Why this matters

• Prospective policyholders:
  Identity screening may be part of enrollment or verification processes.
   
• Current policyholders:
  Ongoing compliance checks may occur during policy servicing.
   
• Agents/brokers:
  Mandatory compliance obligation alongside AML requirements.
   

A government program providing health coverage to eligible children in low- to moderate-income families.

Why this matters

• Prospective policyholders:
  Children may qualify for CHIP even when parents do not qualify for Medicaid or ACA subsidies.
   
• Current policyholders:
  Changes in income or household size can shift children between CHIP and Marketplace coverage.
   
• Agents/brokers:
  Important for proper household coverage placement and eligibility guidance.
   

Insurance coverage that pays a lump-sum benefit upon diagnosis of a serious illness such as cancer, heart attack, or stroke.

Why this matters

• Prospective policyholders:
  Provides financial protection beyond traditional health insurance.
   
• Current policyholders:
  Benefits can be used for non-medical expenses during recovery.
   
• Agents/brokers:
  Often positioned as a supplemental solution to offset high out-of-pocket exposure.
   

An ACA-related notice issued when a consumer is transitioned from one insurer to another.

Why this matters

• Prospective policyholders:
  Indicates changes in plan availability or issuer participation.
   
• Current policyholders:
  May require action to confirm coverage details or provider networks.
   
• Agents/brokers:
  Signals the need for proactive client communication and plan review.
   

The federal agency that administers Medicare, Medicaid, and the ACA Marketplace.

Why this matters

• Prospective policyholders:
  Sets the rules governing ACA plan eligibility and enrollment.
   
• Current policyholders:
  Oversees plan standards, appeals, and enforcement actions.
   
• Agents/brokers:
  Primary regulatory authority for Marketplace and Medicare compliance.
   

ACA assistance that reduces deductibles, copays, and out-of-pocket costs for eligible Silver plan members.

Why this matters

• Prospective policyholders:
  Can significantly improve the value of coverage beyond premium savings alone.
   
• Current policyholders:
  Loss of eligibility can dramatically increase healthcare costs.
   
• Agents/brokers:
  One of the most impactful tools for improving ACA plan outcomes.
   

A U.S. law requiring certain business entities to report ownership information.

Why this matters

• Prospective policyholders:
  Business owners may be subject to additional reporting requirements.
   
• Current policyholders:
  Ownership changes may trigger compliance obligations.
   
• Agents/brokers:
  Relevant when working with business clients or entity-based policies.
   

A report required for certain large cash transactions.

Why this matters

• Prospective policyholders:
  Rarely encountered, but may arise in unusual payment situations.
   
• Current policyholders:
  Large financial transactions may be flagged for review.
   
• Agents/brokers:
  Part of broader financial compliance responsibilities.

A U.S. immigration policy that provides temporary relief from deportation and work authorization for certain individuals brought to the U.S. as children.

Why this matters

• Prospective policyholders:
  Immigration status can affect eligibility for certain health coverage options.
   
• Current policyholders:
  Changes in status may impact continued eligibility or enrollment options.
   
• Agents/brokers:
  Must understand eligibility rules to properly guide coverage pathways.
   

An ACA enrollment method that allows consumers to enroll through approved partners rather than directly on Healthcare.gov.

Why this matters

• Prospective policyholders:
  Provides alternative enrollment channels that may be more user-friendly.
   
• Current policyholders:
  Updates or changes may be processed through the original enrollment channel.
   
• Agents/brokers:
  Enables streamlined enrollment workflows while maintaining Marketplace compliance.
   

A process used to match death records to insurance enrollments.

Why this matters

• Prospective policyholders:
  Generally invisible, but supports system accuracy.
   
• Current policyholders:
  Ensures coverage is properly terminated to prevent errors or fraud.
   
• Agents/brokers:
  Helps maintain accurate enrollment records and compliance.
   

A blockchain-based financial system that operates without traditional intermediaries.

Why this matters

• Prospective policyholders:
  Rarely relevant, but may appear in financial compliance reviews.
   
• Current policyholders:
  Uncommon in insurance transactions, but occasionally referenced in compliance contexts.
   
• Agents/brokers:
  Awareness is useful when dealing with non-traditional financial activity.
   

Problems that occur when eligibility or identity data does not match across systems.

Why this matters

• Prospective policyholders:
  Can delay enrollment or subsidy approval until resolved.
   
• Current policyholders:
  May temporarily suspend subsidies or coverage if not addressed.
   
• Agents/brokers:
  Requires prompt documentation and follow-up to prevent coverage gaps.
   

A state agency responsible for regulating insurance carriers and agents.

Why this matters

• Prospective policyholders:
  Acts as a consumer protection authority if disputes arise.
   
• Current policyholders:
  Oversees complaint resolution and carrier conduct.
   
• Agents/brokers:
  Primary licensing and regulatory body at the state level.
   

A Medicare Advantage plan designed for individuals eligible for both Medicare and Medicaid.

Why this matters

• Prospective policyholders:
  Offers enhanced benefits and coordinated care for dual-eligible individuals.
   
• Current policyholders:
  Can provide additional services beyond standard Medicare coverage.
   
• Agents/brokers:
  Requires specialized knowledge and strict compliance with Medicare rules.

Healthcare providers that serve predominantly low-income, medically underserved, or special-needs populations.

Why this matters

• Prospective policyholders:
  Ensures access to providers that specialize in serving vulnerable or underserved communities.
   
• Current policyholders:
  Affects whether trusted community clinics or hospitals are included in a plan’s network.
   
• Agents/brokers:
  Important when evaluating network adequacy and access standards.
   

A more intensive level of identity or compliance review beyond standard verification.

Why this matters

• Prospective policyholders:
  Additional documentation may be required before coverage is finalized.
   
• Current policyholders:
  Certain changes or updates can trigger extra verification steps.
   
• Agents/brokers:
  Requires proactive documentation management to avoid enrollment delays.
   

An ACA-approved enrollment pathway using certified third-party platforms integrated with the Marketplace.

Why this matters

• Prospective policyholders:
  Offers a streamlined, often more intuitive enrollment experience.
   
• Current policyholders:
  Changes and renewals may be managed through the original enrollment platform.
   
• Agents/brokers:
  Enables efficient enrollment while remaining fully Marketplace-compliant.
   

A unique identifier assigned to certain Marketplace enrollment events.

Why this matters

• Prospective policyholders:
  Often tied to Special Enrollment Periods triggered by life events.
   
• Current policyholders:
  Helps track and verify enrollment actions.
   
• Agents/brokers:
  Useful for troubleshooting SEP processing and documentation issues.
   

Financial abuse or exploitation of older adults.

Why this matters

• Prospective policyholders:
  Provides protections for seniors during financial and insurance transactions.
   
• Current policyholders:
  Helps prevent unauthorized changes or misuse of funds.
   
• Agents/brokers:
  Requires vigilance and reporting when exploitation is suspected.
   

The ten categories of benefits that ACA-compliant plans are required to cover.

Why this matters

• Prospective policyholders:
  Confirms whether a plan offers comprehensive coverage or limited benefits.
   
• Current policyholders:
  Explains why certain services must be covered under ACA rules.
   
• Agents/brokers:
  Forms the baseline for comparing ACA plans to private or non-ACA options.
   

Health insurance offered through an employer.

Why this matters

• Prospective policyholders:
  Access to employer coverage can affect eligibility for ACA subsidies.
   
• Current policyholders:
  Job changes or employer coverage changes may open or close enrollment options.
   
• Agents/brokers:
  Critical factor when evaluating subsidy eligibility and alternative coverage strategies.

An international organization that sets standards to combat money laundering and terrorist financing.

Why this matters

• Prospective policyholders:
  Rarely visible, but contributes to identity and financial screening standards used during enrollment.
   
• Current policyholders:
  Ongoing compliance rules may affect documentation or verification requests.
   
• Agents/brokers:
  Influences global AML/CFT standards that flow into U.S. compliance requirements.
   

The federal ACA Marketplace platform, commonly known as Healthcare.gov.

Why this matters

• Prospective policyholders:
  This is where eligibility for ACA plans, subsidies, and CSRs is determined in federally run states.
   
• Current policyholders:
  Annual renewals, income updates, and plan changes are processed through this system.
   
• Agents/brokers:
  Primary enrollment and servicing platform for ACA business in FFM states.
   

A bureau of the U.S. Treasury responsible for enforcing financial crime regulations.

Why this matters

• Prospective policyholders:
  Identity verification and screening may be part of the enrollment process.
   
• Current policyholders:
  Certain financial activities may trigger additional compliance review.
   
• Agents/brokers:
  Oversees AML, BSA, and reporting obligations tied to insurance transactions.
   

A federal law establishing standards for protecting sensitive government and consumer data.

Why this matters

• Prospective policyholders:
  Helps ensure personal and financial information is safeguarded during enrollment.
   
• Current policyholders:
  Protects ongoing data related to coverage and eligibility.
   
• Agents/brokers:
  Sets security expectations for systems handling federal or Marketplace data.
   

An income benchmark used to determine eligibility for ACA subsidies, Medicaid, and other assistance programs.

Why this matters

• Prospective policyholders:
  Determines whether you qualify for premium tax credits or cost-sharing reductions.
   
• Current policyholders:
  Income changes that move you across FPL thresholds can alter subsidies or coverage type.
   
• Agents/brokers:
  Precise FPL calculations are essential for correct placement and compliance.
   

Tax data that is subject to strict confidentiality and handling requirements.

Why this matters

• Prospective policyholders:
  Income verification relies on protected tax information.
   
• Current policyholders:
  Ensures sensitive financial data remains confidential.
   
• Agents/brokers:
  Must follow strict rules when accessing or handling tax-related data.
   

Occurs when a household does not reconcile ACA subsidies on their federal tax return.

Why this matters

• Prospective policyholders:
  Prior FTR status can limit future subsidy eligibility.
   
• Current policyholders:
  Failure to reconcile may require full premium payment until resolved.
   
• Agents/brokers:
  Critical compliance issue that must be addressed to restore subsidy access.

A rule requiring insurers to offer coverage regardless of health status or pre-existing conditions (applies primarily to ACA-compliant plans).

Why this matters

• Prospective policyholders:
  You cannot be denied coverage or charged more due to medical history when enrolling in ACA plans.
   
• Current policyholders:
  Provides protection if your health changes while you’re insured.
   
• Agents/brokers:
  Critical distinction when explaining differences between ACA-compliant plans and medically underwritten private plans.

The federal department responsible for administering health programs and enforcing healthcare regulations, including the ACA.

Why this matters

• Prospective policyholders:
  HHS sets the rules that determine how ACA plans operate and what protections apply.
   
• Current policyholders:
  Oversees enforcement, appeals processes, and consumer protections affecting your coverage.
   
• Agents/brokers:
  Issues regulatory guidance and policy updates that directly impact enrollment and compliance.
   

An internal system used to manage insurance-related cases, appeals, and operational issues.

Why this matters

• Prospective policyholders:
  Rarely encountered directly, but supports accurate case handling.
   
• Current policyholders:
  Used to track appeals, corrections, or coverage issues.
   
• Agents/brokers:
  Important for resolving complex enrollment or servicing problems.
   

A health plan that typically requires selecting a primary care physician and obtaining referrals for specialist care.

Why this matters

• Prospective policyholders:
  Often offers lower premiums but requires staying within a defined provider network.
   
• Current policyholders:
  Understanding referral and network rules helps avoid unexpected out-of-pocket costs.
   
• Agents/brokers:
  Must ensure clients understand access limitations before enrollment.
   

An employer-funded account that reimburses employees for eligible medical expenses.

Why this matters

• Prospective policyholders:
  May reduce personal healthcare costs when offered by an employer.
   
• Current policyholders:
  Understanding eligible expenses maximizes benefit use.
   
• Agents/brokers:
  Key strategy for employers seeking flexible, tax-advantaged benefits.

Health insurance purchased directly by individuals or families, rather than through an employer.

Why this matters

• Prospective policyholders:
  IFP coverage is often the primary option for self-employed individuals, freelancers, early retirees, and those without employer benefits.
   
• Current policyholders:
  Premiums, subsidies, and plan options may change annually, making periodic review important.
   
• Agents/brokers:
  Core market segment requiring careful balance between ACA and private-plan strategies.
   

An employer benefit that reimburses employees for individual health insurance premiums and qualified medical expenses.

Why this matters

• Prospective policyholders:
  Can provide employer-funded support while allowing you to choose your own individual plan.
   
• Current policyholders:
  Understanding coordination between the ICHRA and ACA subsidies is critical to avoid conflicts.
   
• Agents/brokers:
  Powerful alternative to traditional group plans, requiring precise compliance and education.

A set of identity verification requirements used to confirm the identity of individuals during enrollment and financial transactions.

Why this matters

• Prospective policyholders:
  You may be required to provide identification or additional documentation before coverage can be issued.
   
• Current policyholders:
  Certain policy changes or updates may trigger renewed identity verification.
   
• Agents/brokers:
  Mandatory compliance step that helps prevent fraud and protects the integrity of the enrollment process.

The specific type of insurance an agent is licensed to sell (such as health, life, or Medicare).

Why this matters

• Prospective policyholders:
  Ensures the person advising you is legally authorized to sell and service the type of insurance you’re considering.
   
• Current policyholders:
  Confirms your agent is properly licensed to assist with changes, renewals, or claims-related questions.
   
• Agents/brokers:
  Defines legal scope of practice and determines which products can be marketed or sold.

The income calculation used to determine eligibility for ACA subsidies.

Why this matters

• Prospective policyholders:
  MAGI—not gross income—determines whether you qualify for premium tax credits and CSRs.
   
• Current policyholders:
  Even small income changes can significantly affect premiums and tax outcomes.
   
• Agents/brokers:
  Essential for accurate subsidy planning, especially for self-employed households.
   

Health coverage that meets federal minimum requirements.

Why this matters

• Prospective policyholders:
  Not all health plans qualify as MEC, even if they sound comprehensive.
   
• Current policyholders:
  Knowing whether your plan is MEC helps avoid compliance or coverage gaps.
   
• Agents/brokers:
  Critical distinction when comparing ACA, employer, and private plans.
   

A category of health benefits related to mental health and addiction treatment.

Why this matters

• Prospective policyholders:
  Ensures access to behavioral health services when choosing a plan.
   
• Current policyholders:
  Affects access to therapy, counseling, and treatment programs.
   
• Agents/brokers:
  Important when evaluating parity and benefit adequacy.
   

Federal law requiring mental health benefits to be covered comparably to medical benefits.

Why this matters

• Prospective policyholders:
  Prevents plans from limiting mental health care unfairly.
   
• Current policyholders:
  Supports appeals if mental health coverage is restricted.
   
• Agents/brokers:
  Key compliance and advocacy framework.
   

Training platform for ACA Marketplace education.

Why this matters

• Prospective policyholders:
  Ensures agents assisting you are properly trained.
   
• Current policyholders:
  Supports accurate guidance during renewals and changes.
   
• Agents/brokers:
  Required training environment for Marketplace certification.
   

Official communications regarding Open Enrollment.

Why this matters

• Prospective policyholders:
  Alerts you to enrollment windows and deadlines.
   
• Current policyholders:
  Provides reminders to review or update coverage.
   
• Agents/brokers:
  Triggers outreach and compliance actions.

Organization of state insurance regulators.

Why this matters

• Prospective policyholders:
  Helps ensure consistent consumer protections across states.
   
• Current policyholders:
  Oversees carrier standards and solvency.
   
• Agents/brokers:
  Establishes model laws and best practices.
   

Unique identifier for licensed insurance agents.

Why this matters

• Prospective policyholders:
  Confirms your agent is properly licensed.
   
• Current policyholders:
  Ensures accountability and traceability.
   
• Agents/brokers:
  Required for all appointments and transactions.

The annual window to enroll in or change ACA plans.

Why this matters

• Prospective policyholders:
  Missing OE may mean waiting months for coverage.
   
• Current policyholders:
  Plans, prices, and networks change every year.
   
• Agents/brokers:
  Most time-sensitive enrollment period.
   

U.S. agency enforcing sanctions compliance.

Why this matters

• Prospective policyholders:
  Identity screening may occur during enrollment.
   
• Current policyholders:
  Certain transactions may be restricted.
   
• Agents/brokers:
  Mandatory compliance check.
   

Federal office overseeing budgeting and policy implementation.

Why this matters

• Prospective policyholders:
  Influences healthcare funding and program rules.
   
• Current policyholders:
  Affects future program changes.
   
• Agents/brokers:
  Policy direction context.
   

Restrictions tied to plan benefit categories.

Why this matters

• Prospective policyholders:
  Helps identify coverage gaps.
   
• Current policyholders:
  Explains denied or limited claims.
   
• Agents/brokers:
  Important during plan comparisons.
   

Ongoing eligibility verification process.

Why this matters

• Prospective policyholders:
  Ensures accurate enrollment.
   
• Current policyholders:
  May trigger documentation requests.
   
• Agents/brokers:
  Requires proactive follow-up.
   

A healthcare provider network.

Why this matters

• Prospective policyholders:
  Determines which doctors are accessible.
   
• Current policyholders:
  Impacts cost and provider access.
   
• Agents/brokers:
  Network evaluation is critical.
   

Sensitive personal data protected by law.

Why this matters

• Prospective policyholders:
  Your data must be handled securely.
   
• Current policyholders:
  Protects privacy and identity.
   
• Agents/brokers:
  Strict handling requirements.
   

Plan type offering broader provider flexibility.

Why this matters

• Prospective policyholders:
  More flexibility, usually higher cost.
   
• Current policyholders:
  Fewer referral requirements.
   
• Agents/brokers:
  Useful for clients prioritizing access.
   

Tax credit used to reduce ACA premiums.

Why this matters

• Prospective policyholders:
  Determines true cost of coverage.
   
• Current policyholders:
  Requires reconciliation at tax time.
   
• Agents/brokers:
  Core affordability lever.
   

The calendar year a policy applies to.

Why this matters

• Prospective policyholders:
  Benefits reset annually.
   
• Current policyholders:
  Deductibles restart each year.
   
• Agents/brokers:
  Timing matters for enrollment.
   

Factor used in premium calculations.

Why this matters

• Prospective policyholders:
  Explains rate increases.
   
• Current policyholders:
  Impacts renewal pricing.
   
• Agents/brokers:
  Used in rate analysis.
   

An ACA-approved plan meeting federal standards.

Why this matters

• Prospective policyholders:
  Required for subsidies.
   
• Current policyholders:
  Guarantees ACA protections.
   
• Agents/brokers:
  Baseline eligibility requirement.
   

Life event triggering a Special Enrollment Period.

Why this matters

• Prospective policyholders:
  Unlocks coverage outside OE.
   
• Current policyholders:
  Timing and proof are critical.
   
• Agents/brokers:
  High-compliance enrollment path.
   

Dental coverage purchased separately.

Why this matters

• Prospective policyholders:
  Medical plans may not include dental.
   
• Current policyholders:
  Separate premiums and benefits apply.
   
• Agents/brokers:
  Supplemental solution.
   

Financial crime reporting mechanism.

Why this matters

• Prospective/Current policyholders:
  Generally invisible.
   
• Agents/brokers:
  Mandatory compliance duty.
   

State ACA marketplaces using federal technology.

Why this matters

• Prospective policyholders:
  Enrollment rules vary by state.
   
• Current policyholders:
  Notices and processes differ.
   
• Agents/brokers:
  Requires state-specific knowledge.
   

Sanctions list designation.

Why this matters

• Prospective/Current policyholders:
  Identity screening may apply.
   
• Agents/brokers:
  Compliance obligation.
   

Federal securities regulator.

Why this matters

• Business policyholders:
  Affects financial disclosures.
   
• Agents/brokers:
  Regulatory overlap awareness.
   

Enrollment window outside OE.

Why this matters

• Prospective policyholders:
  Miss the window, wait months.
   
• Current policyholders:
  Incorrect use can void coverage.
   
• Agents/brokers:
  Audit-sensitive process.
   

Proof required for SEP eligibility.

Why this matters

• Prospective policyholders:
  Documentation is required.
   
• Current policyholders:
  Failure may cancel coverage.
   
• Agents/brokers:
  Must collect and submit correctly.
   

ACA marketplace for small employers.

Why this matters

• Prospective policyholders:
  Option for offering benefits.
   
• Current policyholders:
  Simplifies compliance.
   
• Agents/brokers:
  Underused group strategy.
   

Employer reimbursement strategy.

Why this matters

• Prospective employers:
  Cost-control option.
   
• Current participants:
  Tax efficiency.
   
• Agents/brokers:
  Advanced planning tool.
   

Individual with specialized knowledge.

Why this matters

• All parties:
  Expertise improves outcomes.
   

Additional Medicare Advantage benefits.

Why this matters

• Prospective policyholders:
  Expanded care options.
   
• Current policyholders:
  Access to non-medical benefits.
   
• Agents/brokers:
  Medicare differentiation tool.
   

Problems verifying SEP eligibility.

Why this matters

• Prospective/Current policyholders:
  Can delay or cancel coverage.
   
• Agents/brokers:
  Requires fast resolution.
   

Benchmark for healthcare pricing.

Why this matters

• Prospective policyholders:
  Out-of-network costs may apply.
   
• Current policyholders:
  Affects balance billing.
   
• Agents/brokers:
  Explains cost exposure.
   

Immigration services agency.

Why this matters

• Prospective policyholders:
  Status affects eligibility.
   
• Agents/brokers:
  Documentation awareness.
   

Plan designs encouraging high-value care.

Why this matters

• Prospective policyholders:
  Better health outcomes.
   
• Current policyholders:
  Lower long-term costs.
   
• Agents/brokers:
  Quality-driven plan selection.