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INSUR {CBCS-CPC}
Private Payers/ACA Plans
| Term | Definition |
|---|---|
| administrative services only (ASO) | Contract under which a third-party administrator or an insurer agrees to provide administrative services to an employer in exchange for a fixed fee per employee. |
| BlueCard | A BlueCross BlueShield program that provides benefits for plan subscribers who are away from their local areas. |
| BlueCross BlueShield Association (BCBS) | A national healthcare licensing association of more than forty payers. |
| concierge medicine | A primary care arrangement with a patient under which the provider agrees to accept a retainer in exchange for enhanced care and access to the patient. |
| Consolidated Omnibus Budget Reconciliation Act (COBRA) | Federal law requiring employers with more than twenty employees to allow employees who have been terminated for reasons other than gross misconduct to pay for coverage under the employer’s group health plan for eighteen months after termination. |
| credentialing | Periodic verification that a provider or facility meets the professional standards of a certifying organization; physician credentialing involves screening and evaluating qualifications and other credentials, including licensure, required education, relevant training and experience, and current competence. |
| direct primary care (DPC) | An arrangement between a provider and a patient that removes an insurance plan; it is usually paired with either a high-deductible health plan or an HRA/FSA. |
| discounted fee-for-service | A negotiated payment schedule for healthcare services based on a reduced percentage of a provider’s usual charges. |
| elective surgery | Nonemergency surgical procedure that can be scheduled in advance. |
| Employee Retirement Income Security Act (ERISA) of 1974 | A federal law that provides incentives and protection against litigation for companies that set up employee health and pension plans. |
| episode-of-care (EOC) option | A flat payment by a health plan to a provider for a defined set of services, such as care provided for a normal pregnancy, or for services for a certain period of time, such as a hospital stay. |
| essential health benefits (EHB) | Required benefits that must be offered by metal plans as well as some other insurance plans. |
| family deductible | Fixed, periodic amount that must be met by the combination of payments for covered services to each individual of an insured/dependent group before benefits from a payer begin. |
| Federal Employees Health Benefits (FEHB) program | The health insurance program that covers employees and retirees and their families of the federal government. |
| Flexible Blue | The BlueCross BlueShield consumer-driven health plan. |
| flexible savings (spending) account (FSA) | Type of consumer-driven health funding plan option that has employer and employee contributions; funds left over revert to the employer. |
| formulary | A list of a health plan’s selected drugs and their proper dosages; often a plan pays only for the drugs it lists. |
Created by:
VA_MedCod3r