Glossary of Health Insurance Terms

See "Blue Cross Blue Shield Association."

See "Blue Cross and Blue Shield of Kansas City."

See "Blue Cross and Blue Shield of Kansas, Inc."

The extent or degree of service a patient is entitled to receive based on their health insurance contract.

Healthcare services offered under the terms of a health insurance policy.

The designated time period during which, covered medical services are reimbursable by BCBSKS. This can be a calendar year or a contract -anniversary year as determined by the effective date of the patient's contract.

Specific kinds of medical services that are grouped together under provisions of the patient's contract. Examples would be: lab and x-ray; outpatient psychiatric; prescription drugs.

The dollar amount available for the cost of covered medical services.

A health maintenance organization, developed by BCBSKC, which provides a comprehensive set of health maintenance and treatment services for enrolled members. This product is no longer being sold in our jurisdiction -BCBSKS service area, effective 1-1-99.

A type of health insurance coverage that BCBSKS sells. This coverage has open access to all CAP contracting providers, meaning referrals from a PCP are not required. This coverage is considered a PPO type of contract.

An entity that provides health insurance coverage in the Kansas City, Missouri metropolitan area including Johnson and Wyandotte counties in Kansas. BCBSKC operates independently of other BCBS Plans.

An entity that provides health insurance coverage in Kansas excluding Johnson and Wyandotte counties. The home office is in Topeka. Referred to in this manual as BCBSKS. BCBSKS operates independently of other BCBS Plans.

The national organization of Blue Cross and Blue Shield Plans in the United States, territories and Western Europe. The association is headquartered in Chicago, Illinois, and coordinates the efforts of the Plans at a national level.

The part of BCBSKS that is responsible for facility -i.e. hospital, hospice, home health agencies, etc. coverage and benefits.

A BCBS entity usually referring to BCBSKS, but can be any other BCBS Plan. BCBSKS is not actually a Plan but is legally a mutual company.

A type of health insurance coverage that BCBSKS sells. This is a form of managed care and has two levels of benefits: PCP referred services and patient self-referred services. This coverage is considered a POS type of contract.

The part of BCBSKS that is responsible for professional -i.e. doctor, ambulance, dental, etc. coverage and benefits.

A teleprocessing system, in which BCBSKS participates, that serves Blue Cross and Blue Shield -BCBS members anywhere in the United States. This process is sometimes referred to as "ITS". Through this system, BCBS Plans make available to BCBS members the same provider discounts they have negotiated for their own customers. Claims for patients who have out-of -state coverage by another Blue Plan, are usually sent directly to BCBSKS. This program does not include HMO claims.

A group of providers who have agreed to provide vision services -eye exams and/or corrective lenses to Boeing participants at a discounted amount.

See "Blue Cross Blue Shield Association."

The act of combining procedures where one procedure is considered part of another procedure. The reimbursement could be based on a global fee for all services, or it could be based on the procedure with the highest RVU. See "Content of Service" and "Unbundling."

Boeing Vision Exam. See "Boeing Vision Network."

Boeing Vision Hardware -i.e. glasses, contact lenses. See "Boeing Vision Network."

See "Boeing Vision Network."