Glossary of Health Insurance Terms

See "Comprehensive major medical."

The greatest total amount that a patient's contract will pay out, in the patient's lifetime.

Contractual restrictions placed on services or benefits as specified in a patient's contract.

Refers to the categories of activities at BCBSKS relative to type of claim and where the money comes from to pay the claim. Examples would be Blue Cross, Medicare Part B, Blue Shield, Medicare Part A and Medicaid. Originally this was an accounting term used to identify the line or the budget being affected. Today it has carried over to help identify where the benefits fit in the patient's contract. Can also refer to the type of services paid by BCBSKS as in professional, drug, in-hospital, outpatient hospital, and dental.

See "Line of Business."

This is the third level of the Health Care Financing Administration Common Procedure Coding System. These codes and their nomenclature are unique to the Medicare Carrier or the insurance carrier and are assigned by them.

A patient agreement -contract, underwritten and administered by BCBSKS.

The maximum amount for which a patient is responsible for covered services during their contract year.

Licensed Practical Nurse.

Licensed Speech Pathologist.