Glossary of Health Care Terms

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

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Alternative care: Alternative care typically means services provided by chiropractors, naturopaths, acupuncturists, and massage therapists.

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.

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.
Copay: A fixed dollar amount the member pays the provider when they receive a medical service.

Deductible: A fixed, annual dollar amount that a member pays for medical services before Regence begins paying for covered medical services.

Endodontics: A restorative treatment for the center of a tooth, such as root canal therapy.

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.

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

Lifetime Maximum: The maximum amount Regence pays for covered expenses across coverage years for each member.

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.

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.

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 you use health care services. Your deductible, copay 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 on how much you have to pay for your covered medical expenses in a calendar year. This amount varies by plan. After you have reached your out-of-pocket maximum, Regence pays 100% of remaining covered medical expenses in a calendar year.

PPO: Preferred Provider Organization (PPO) plans generally cover any provider. Members get more coverage and lower out-of-pocket costs for seeing 'preferred' network providers.
Participating Provider Network: Providers (such as hospitals and physicians) who have agreed to provide services to Regence members at set rates.
Preferred Provider: A group of selected health care providers (such as hospitals and physicians) who agree to provide Regence members with services at a negotiated rate.
Preferred Provider Network: Providers (such as hospitals and physicians) who agree to charge a pre-negotiated rate for everyone on a particular health plan.
Premium: The amount an individual pays for coverage.
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).

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.

Traditional Plan: A type of health plan with no provider network limitations. These plans have the widest provider choice, but can be expensive.

Wellness programs: Programs that promote safety and good health. For example: discounted gym fees, smoking cessation, and nurse hotline.