Glossary

This is indemnity insurance. Doctors and hospitals are paid for each service they perform/provide. (See Traditional)

Employer-established benefit plans that reimburse employees for specified medical expenses as they are incurred. These accounts are allowed under section 125 of the Internal Revenue Code and are also referred to as "cafeteria plans" or "125 plans." The employee contributes funds to the account through a salary reduction agreement and is able to withdraw the funds set aside to pay for medical bills. The salary reduction agreement means that any funds set aside in a flexible spending account escape both income tax and Social Security tax. Employers may contribute to these accounts as well. By law, the employee forfeits any unspent funds in the account at the end of the year.

Includes, but is not limited to, any of the following: (1) breach of contract; (2) a civil case ruling, settlement in a civil or criminal matter, a verdict or plea of guilty or a plea of nolo contendere, and/or any other instance determined by BCBSKS as moral turpitude; and/or (3) any act of defamation, slander, and libel toward BCBSKS and its subsidiaries (as determined by BCBSKS).

A list of preferred, commonly prescribed prescription drugs. These drugs are chosen by a team of doctors and pharmacists because of their clinical superiority, safety, ease of use and cost.

A deception that could result in BCBSKS paying for something it shouldn't. For example, if a provider files a claim for a service that wasn't received, this is fraud.