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Commercial and BCBS
Commercial and BCBS Insurance Vocabulary
| Term | Definition |
|---|---|
| individual health insurance | private health insurance policy purchased solely by individuals or families who do not have access to group health insurance coverage |
| group health insurance | traditional health coverage subsidized by employers and other organizations (labor unions, etc) whereby part or all of premium costs are paid for by group or discounted group rates are offered to eligible individuals |
| automobile insurance policy | contract between an individual and an insurance company whereby the individual pays a premium and, in exchange, the insurance company agrees to pay for specific car-related financial losses during the term of the policy |
| auto indemnity insurance | compensates policyholders for actual economic losses, up to limiting amounts on insurance policy. usually requires insured to prove loss prior to payment. |
| disability insurance | reimbursement for income lost as a result of a temporary or permanent illness or injury |
| liability insurance | policy that covers losses to a third party caused by the insured, by an object owned by the insured, or on the premises owned by the insured |
| blue cross | insurance plan created in 1929 designed to cover minimal hospitalization coverage on a yearly basis. |
| blue shield | incorporates a concept of voluntary health insurance that encourages providers to cooperate with prepaid health plans. |
| BCBS indemnity coverage | offers choice and flexibility to subscribers who want to receive a full range of benefits along with the freedom to use any licensed health care provider. |
| outpatient pretreatment authorization plan (OPAP) | AKA: prospective authorization or precertification; requires pre-authorization of outpatient physical, occupational, and speech therapy services |
| second surgical opinion (SSO) | second physician is asked to evaluate the necessity of surgery and recommend the most economical, appropriate facility in which to perform the surgery |
| BlueCard Program | allows BCBS subscribers to receive local Blue Plan health care benefits while traveling or living outside of their plan's area |
| Away from Home Care program | provides continuous BCBS health care coverage for subscribers who will be out of their service area for more than 90 consecutive days. |
| BlueWorldwide Expat | provides global medical coverage for active employees and their dependents who spend more than six months outside the US |
| Blue Cross Blue Shield basic coverage | BCBS coverage for the following services: hospitalization, diagnostic laboratory services, x-rays, surgical fees, assistant surgeon fees, obstetric care, intensive care, newborn care, and chemotherapy for cancer. |
| Blue Cross Blue Shield major medical (a) | BCBS coverage for services, in addition to basic coverage |
| BCBS major medical includes (b) | office visits, outpatient nonsurgical treatment, physical & occupational therapy, purchase of DME, mental health visits, allergy testing and injections, private duty nursing, and accidental injury dental care |
Created by:
tina.reynolds
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