A
- alternative care
- Alternative care typically means services provided by chiropractors, naturopaths, acupuncturists, and massage therapists.
B
- BlueCard®
- A national program that lets members of one Blue Cross Blue Shield company obtain health care services while traveling or living in another Blue company's service area. BlueCard Worldwide® provides members with access to a network of traditional inpatient, outpatient and professional healthcare providers around the world. The program includes a range of medical assistance and claim support services for members traveling or living in countries outside their Home Plan service area. Visit the BlueCard Doctor and Hospital finder Web site.
C
- COBRA
- Temporary continuation of health coverage at group rates available to certain former employees, retirees, spouses, and dependent children when coverage is lost due to a qualifying event, such as loss of employment. Generally, COBRA participants pay the entire premium themselves.
- coinsurance
- The percentage a member pays toward the total negotiated charges for medical services.
- coinsurance maximum
- The coinsurance maximum is the part a member would have to pay in a year for their portion of the covered expense. After that, Regence pays 100% of all covered expenses, up to the lifetime maximum.
- coordination of benefits (COB)
- A person can have more than one kind of insurance coverage, say one plan from their employer and one from their spouse's employer. In that case, the two health plans work together to coordinate which one pays first, and how much. This process is called coordination of benefits.
- copay
- A fixed dollar amount the member pays the provider when they receive a medical service.
D
- deductible
- A fixed, annual dollar amount that a member pays for medical services before Regence begins paying for covered medical services.
- dependent
- Another person, such as a child or a spouse, who is legally eligible to benefits under a member's health plan.
E
- effective date
- The date when coverage begins or takes effect.
- endodontics
- A restorative treatment for the center of a tooth, such as root canal therapy.
- explanations of benefits (EOB)
- A description of the benefits paid for a particular claim. A health plan sends an EOB to a patient after the patient receives services from a provider. Also called a "claims processing report."
F
- formulary
- List of prescription medications covered by a health plan. Formularies can be open, meaning you may get some coverage for medications not on the list, or closed, meaning only medications on the list are covered. Formularies are also called Preferred Medication Lists.
G
- generic drugs
- Prescription medications that have the exact same active ingredients and strength as brand-name medications. Generics, as they're often called, are equal in therapeutic power to their brand-name counterparts. Health plans often encourage use of generics because they are usually significantly less expensive.
- group health plan
- A plan offered by an employer or an employee organization (such as a union) to provide medical coverage to employees, retirees and/or their dependents.
H
- health maintenance organization (HMO)
- A type of health plan that requires subscribers to receive all medical care from network providers, usually under the direction of a primary care physician (PCP).
- health savings account (HSA)
- A special kind of savings account always paired with a high-deductible health plan. You put pre-tax money in the account, and then use it for medical, retirement, or long-term care expenses. The funds can roll over from year to year. You can take them with you when you change jobs.
Learn more about how HSAs work
I
- incentive dental
- A dental plan where benefits increase each year if you see a dentist for covered services. In other words, members have an 'incentive' to receive regular dental care.
- indemnity plans
- Historically, this term has been used to apply to products that pay benefits as a flat dollar amount (for example: $100 per day for a hospital room). More recently, it has come to be used for any traditional (non-PPO, non-HMO) medical plan.
- individual coverage
- A policy that provides coverage to an individual or family, where they pay a premium directly to a health plan instead of through an employer.
J
K
L
- lifetime maximum
- The maximum amount Regence pays for covered expenses across coverage years for each member.
M
- Medicare
- A two-part federal program that helps with medical costs for those over 65 or permanently disabled. Medicare Part A covers some inpatient hospital expenses for everyone enrolled at no cost. Part B is optional, and covers physicians' services, outpatient care and more for a small cost to enrollees.
- Medicare Advantage
- A type of health plan that compliments federal Medicare coverage. These plans cover costs like preventive care, prescriptions, at-home care, and more.
- Medigap
- A type of health plan that compliments federal Medicare coverage. These plans cover costs like preventive care, prescriptions, at-home care, and more.
N
- network
- See provider network
- no referrals
- No referrals means a member can go directly to a specialist without first seeing their regular doctor.
- non-network providers
- providers (such as hospitals and physicians) who are not part of a particular Regence provider network. Some health plans cover non-network providers, but your costs will almost always be higher.
O
- office visit
- A formal face-to-face contact between you and a health professional in a clinic, office or hospital outpatient area. Same as an 'office call'.
- orthodontia
- A branch of dentistry that deals with abnormalities of the teeth and face.
- out-of-pocket expense
- Money you spend when using health care services. Your deductible and coinsurance are kinds of out-of-pocket expense. Your premium is not usually considered an out-of-pocket expense.
- out-of-pocket maximum
- A maximum amount you'll be responsible for paying toward your covered medical expenses in a calendar year, also known as stop-loss. This amount varies by plan and may not include some kinds of out-of-pocket expenses, such as deductibles and copays for office and pharmacy visits. After you have reached your out-of-pocket maximum, Regence pays 100% of remaining covered medical expenses in a calendar year.
P
- participating provider network
- Providers (such as hospitals and physicians) who have agreed to provide services to patients at rates pre-negotiated by the patient's health plan. Compare to preferred provider network.
- pre-existing condition
- If someone has shown symptoms of a health condition, or been treated for one, before their coverage begins, it is called a pre-existing condition. Usually, there is a limit to how far back a health plan can check for such conditions.
- preferred medication list (PML)
- Prescription medications covered by a health plan. PMLs can be open, meaning you may get some coverage for medications not on the list, or closed, meaning only medications on the list are covered. A preferred medication list can also be called a formulary.
- preferred provider network
- Providers (such as hospitals and physicians) who agree to charge a pre-negotiated rate for everyone on a particular health plan.
- preferred provider organization (PPO)
- PPO plans generally cover any provider. Members get more coverage and lower out-of-pocket costs for seeing 'preferred' network providers.
- premium
- The amount an individual pays for coverage. Same as rate.
- preventive care
- Routine services like well-child care, immunizations, adult physicals and exams, sometimes lab and x-ray that help prevent health issues or detect them early on. Preventive care services vary from plan to plan.
- primary care provider (PCP)
- Your regular doctor or health professional that provides basic care and coordinates other care through referrals to specialists as needed. Some people refer to a PCP as there personal care provider.
- provider
- Providers include hospitals, clinics, physicians, and other health care professionals (such as midwives and nurse practitioners).
- provider network
- A group of providers (such as hospitals and physicians) who agree to a pre-negotiated price for services they provide. To get that price, a patient must be covered by a particular health plan that uses that network. On some health plans, a patient has less or no insurance coverage if they see a provider who is not in their network.
Q
- qualifying event
- Something that happens to make someone eligible for continued insurance coverage under COBRA or state law. Examples of qualifying events: termination of employment, death or divorce.
R
- rate
- The amount an individual pays for coverage. Same as premium.
- RegenceRx Discount Program
- With select Regence health care plans, this program provides discounted prescriptions to everyone with Regence medical coverage, even those without Rx coverage.
S
- second opinion
- Usually refers to potential surgery. A patient may get an opinion from one provider about the best treatment, then ask other providers for their recommendations, or "second opinions." Some health plans require second opinions; others encourage them, but make them voluntary.
- service area
- The geographic area where an insurance company sells and delivers services. A service area can also be product-specific.
- short term disability (STD)
- Coverage intended to provide partial income replacement for people who are disabled for a short time. Regence's partner, Regence Life and Health Insurance, offers STD plans.
- skilled nursing facility (SNF)
- A facility licensed to provide inpatient care, including round-the-clock nursing.
- stop-loss
- See out-of-pocket maximum
T
- traditional plan
- A type of health plan with no provider network limitations. These plans have the widest provider choice, but can be expensive.
U
- underwriting
- The process of identifying and classifying the potential risk of insuring a person or group of people.
- uninsurable
- In health insurance, individuals who are "uninsurable" can't get coverage (or can get it only at higher rates) because of their medical history. It often refers to people who are already seriously ill when they apply for coverage.
- up-front benefit
- A benefit that does not apply towards the deductible. For example, an annual physical could be covered at 100% without first having to meet a deductible.
V
W
- wellness programs
- Programs that promote safety and good health. For example: discounted gym fees, smoking cessation, and nurse hotline.
X
Y
Z
