Glossary

The term "OBRA" means the Omnibus Budget Reconciliation Act.

OBRA of 1986 extended COBRA's coverage requirements to certain bankruptcy proceedings.

OBRA of 1989 extended COBRA coverage for qualified beneficiaries who have pre-existing conditions and for certain disabled individuals, spouses, and dependents of covered employees who are entitled to Medicare.

OBRA of 1990 affected the operation of COBRA's small-employer exemption and allowed states to pay the COBRA premiums of certain low-income people.

OBRA of 1993 contained provisions that extended COBRA's coverage requirements to adopted children.  It also provided regulations on qualified medical child support orders (QMCSOs) and pediatric vaccine coverage.

Out-of-Network Providers are physicians, hospitals, and other medical facilities that do not participate within a plan's contracted network and do not provide health care at discounted fees.  Plans typically consider charges for out-of-network providers at a higher co-insurance leval than for in-network providers.

An out-of-pocket maximum is the total amount in a benefit year that an individual must pay and is not covered under a plan.  Once a covered person meets the out-of-pocket amount within a benefit year, all other covered medical expenses incurred during that same year will be paid in full by the plan, subject to any specific benefit maximums or lifetime maximum benefit limitations.

The term "outpatient" refers to covered persons when they receive medical care, treatment, services, or supplies at a clinic, a physician's office, a hospital (if not registered bed patients at that hospital), an outpatient behavioral care facility, or an outpatient addictions treatment facility.