The Acronym Decoder
Ever sat in a renewal meeting while someone said "the NQTL analysis affects your MHPAEA exposure under the CAA"? Same. Here's every capital-letter combination in benefits, decoded. Bookmark it. Bring it to the meeting.
Stuck on one in context? Ask Blake →
| Acronym | Stands for | What it actually means |
|---|---|---|
| ACA | Affordable Care Act | The 2010 law behind the employer mandate, 1095-C reporting, out-of-pocket caps, and free preventive care. |
| AHP | Association Health Plan | Employers grouping up through a bona fide association to buy or self-fund coverage together. Stricter rules apply since 2024. |
| ALE | Applicable Large Employer | 50+ full-time equivalents across the controlled group. Triggers the employer mandate. |
| ASO | Administrative Services Only | A carrier administering your self-funded plan without taking claims risk. |
| AWP | Average Wholesale Price | The inflated sticker price drug discounts get quoted against. Nobody pays it. |
| BAA | Business Associate Agreement | The HIPAA contract required before a vendor touches your plan’s health data. |
| BOR | Broker of Record | The letter that names your advisor and moves the compensation. Your leverage. |
| BUCA | Blue Cross, UnitedHealthcare, Cigna, Aetna | Shorthand for the national carriers and their families of subsidiaries. |
| CAA | Consolidated Appropriations Act, 2021 | The transparency law: gag clause ban, broker comp disclosure, RxDC, parity analysis, No Surprises Act. |
| CDHP | Consumer-Driven Health Plan | Umbrella term for high-deductible designs paired with an HSA or HRA. |
| CHIP | Children’s Health Insurance Program | State coverage for kids. Triggers an annual employer notice and 60-day special enrollment rights. |
| CMS | Centers for Medicare & Medicaid Services | The agency that runs Medicare, RxDC submissions, gag clause attestations, and Part D disclosures. |
| COB | Coordination of Benefits | The rules for who pays first when someone has two coverages. |
| COBRA | Consolidated Omnibus Budget Reconciliation Act | Continuation coverage after job loss or other events, at up to 102% of full cost. |
| COE | Center of Excellence | A designated facility for high-stakes procedures, chosen on outcomes and bundled price. |
| DCAP | Dependent Care Assistance Program | The dependent care FSA. Pre-tax childcare dollars, heavy testing failures. |
| DOL | Department of Labor | The federal enforcer of ERISA: audits, penalties, and parity analysis requests. |
| DPC | Direct Primary Care | Flat monthly fee for unlimited primary care. HSA-compatible up to $150/month since 2026. |
| EAP | Employee Assistance Program | Short-term counseling and referral benefit. Often free with disability coverage, often forgotten. |
| EBHRA | Excepted Benefit HRA | A small HRA for premiums like dental and vision, capped annually by the IRS. |
| EDI | Electronic Data Interchange | The automated enrollment file feeds between your HRIS, ben admin, and carriers. |
| EOB | Explanation of Benefits | The not-a-bill statement showing how a claim was priced and paid. |
| EPO | Exclusive Provider Organization | In-network only coverage, but no referrals required. |
| ERISA | Employee Retirement Income Security Act | The 1974 federal law that makes you, the employer, responsible for the plan. |
| FMLA | Family and Medical Leave Act | Job-protected leave, with health coverage continued on active-employee terms. |
| FMP | Fair Market Payment | Vitori Health’s claim pricing model: algorithmic fair pricing above Medicare, no network required. |
| FPL | Federal Poverty Line | The basis for the cleanest ACA affordability safe harbor: $129.89/month for 2026 calendar plans. |
| FSA | Flexible Spending Account | Pre-tax medical dollars, $3,400 cap for 2026, use it or (mostly) lose it. |
| GINA | Genetic Information Nondiscrimination Act | Bars using genetic info in coverage and employment. Touches wellness program design. |
| GLP-1 | Glucagon-Like Peptide-1 (receptor agonist) | The Ozempic/Wegovy/Zepbound drug class reshaping pharmacy budgets. |
| GPO | Group Purchasing Organization | In pharmacy: PBM-owned entities collecting manufacturer fees upstream of your rebate terms. |
| HDHP | High Deductible Health Plan | The IRS-defined plan design that unlocks HSA eligibility. |
| HHS | Department of Health and Human Services | Sets ACA cost-sharing limits and runs HIPAA privacy enforcement. |
| HIPAA | Health Insurance Portability and Accountability Act | Special enrollment rights plus privacy and security rules for plan data. |
| HMO | Health Maintenance Organization | Closed network, PCP gatekeeper, lower premiums. |
| HRA | Health Reimbursement Arrangement | Employer-funded account that reimburses medical costs on your rules. |
| HRIS | Human Resources Information System | Your employee system of record. When it drifts, every downstream feed drifts. |
| HSA | Health Savings Account | The triple-tax-advantaged, employee-owned account. $4,400/$8,750 limits for 2026. |
| IBNR | Incurred But Not Reported | Claims that happened but haven’t hit your reports. A real liability to reserve for. |
| ICHRA | Individual Coverage HRA | Defined-contribution health benefits: employees buy individual plans with employer money. |
| IDR | Independent Dispute Resolution | The No Surprises Act arbitration process between plans and out-of-network providers. |
| ISL | Individual Stop-Loss | Per-person catastrophic protection. Same thing as specific stop-loss. |
| MAC | Maximum Allowable Cost | The PBM’s generic price ceiling list. Two MAC lists means spread. |
| MEC | Minimum Essential Coverage | The baseline coverage that satisfies the employer mandate’s offer requirement. |
| MEWA | Multiple Employer Welfare Arrangement | Unrelated employers sharing one plan. Heavily regulated for historical reasons. |
| MHPAEA | Mental Health Parity and Addiction Equity Act | Mental health benefits can’t be more restricted than medical. Now with required written analysis. |
| MLR | Medical Loss Ratio | The ACA’s 80/85% floor on the share of premium spent on care. |
| MRF | Machine-Readable File | The published file of your plan’s real negotiated rates. Public since 2022. |
| MSP | Medicare Secondary Payer | Rules deciding when your plan pays before Medicare. Getting it wrong is expensive. |
| MV | Minimum Value | Plan covers at least 60% of expected costs. The second leg of mandate compliance. |
| NADAC | National Average Drug Acquisition Cost | CMS’s survey of what pharmacies actually pay for drugs. The honest benchmark. |
| NQTL | Non-Quantitative Treatment Limitation | Non-numeric limits like prior auth and network design, tested for parity compliance. |
| NSA | No Surprises Act | The ban on surprise balance bills for emergency and certain out-of-network care. |
| OOPM | Out-of-Pocket Maximum | The annual ceiling on member cost-sharing. $10,600/$21,200 for 2026 ACA plans. |
| PBM | Pharmacy Benefit Manager | The drug benefit middleman. Three of them handle ~80% of U.S. prescriptions. |
| PCORI | Patient-Centered Outcomes Research Institute | The reason self-funded plans file Form 720 every July. $3.84 per covered life this cycle. |
| PCP | Primary Care Physician | The front door of care. HMO and POS plans require members to pick one. |
| PEPM | Per Employee Per Month | The one unit every cost and fee should be quoted in. |
| PHI | Protected Health Information | Health data HIPAA protects. Treat the HR inbox accordingly. |
| POP | Premium Only Plan | The simplest Section 125 plan: pre-tax premium contributions, nothing else. |
| POS | Point of Service | HMO rules with partial out-of-network coverage bolted on. |
| PPO | Preferred Provider Organization | Big network, no referrals, highest premiums. The default nobody questioned. |
| QLE | Qualifying Life Event | Marriage, birth, coverage loss: the events that open mid-year enrollment windows. |
| QMCSO | Qualified Medical Child Support Order | A court order requiring the plan to cover an employee’s child. Has its own notice rules. |
| QSEHRA | Qualified Small Employer HRA | The under-50-employee HRA for reimbursing individual coverage. |
| RBP | Reference-Based Pricing | Paying claims at a multiple of Medicare instead of renting a network. |
| RFP | Request for Proposal | The competitive bid process. Fiduciaries should run one for major vendors periodically. |
| RxDC | Prescription Drug Data Collection | The CAA’s annual drug-spend report to CMS, due June 1. |
| SAR | Summary Annual Report | The participant summary of your Form 5500. Follows every filing. |
| SBC | Summary of Benefits and Coverage | The standardized plan comparison document the ACA requires at enrollment. |
| SMM | Summary of Material Modification | The notice that goes out when the plan materially changes between SPD updates. |
| SPD | Summary Plan Description | ERISA’s required readable description of your plan. A carrier booklet usually isn’t one. |
| TiC | Transparency in Coverage | The rule that made negotiated rates public via machine-readable files. |
| TPA | Third-Party Administrator | The independent firm that processes claims for self-funded plans. |
| UCR | Usual, Customary, and Reasonable | The old method for pricing out-of-network claims. Vague by design. |
| UM | Utilization Management | Prior auth, concurrent review, and friends. Demand results, not activity. |
| WHCRA | Women’s Health and Cancer Rights Act | Mandates mastectomy-related coverage and an annual notice. |
Need more than the expansion? Most of these link to a full definition in the Glossary.
Put it to work
Reading is step one. These do the math on your plan.
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