Blue Cross Blue Shield of Montana - registered marks of the Blue Cross Blue Shield Association

Glossary

COBRA
Consolidated Omnibus Budget Reconciliation Act of 1986. Terminated employees or those who lose coverage because of reduced work hours may be able to buy group coverage for themselves and their families for limited periods of time.


Co-insurance
A predetermined percentage of the Eligible Charges for covered Services that a participant must pay directly to the provider for certain Health Care Services after the Deductible has been met within the Calendar year.


Co-payment
A charge you pay for medical services. Your health care plan covers the remaining medical charges. As an example, you may pay $10.00 for an office visit or a prescription.


Deductible
The Amount of eligible Charges for covered services that a insured must incur and is responsible for paying before major medical benefits and other benefits will be payable.


Elective Surgical Procedure
Any non-emergency surgical procedure which may be scheduled 72 hours or more after the diagnosis or at convenience of the patient or the surgeon without jeopardizing the patients life or causing serious impairment to the patient.


Exclusions
Specific conditions or circumstances in which the policy will not offer benefits.


HDHP (High Deductible Health Plan)
Usually associated with an HSA (See Below). A High deductible health insurance plan, specially designed according to guidelines established by HSA legislation.


HIPAA
Health Insurance Portability and Accountability Act of 1996. It is designed to protect health insurance coverage for workers and their families when they change or lose their jobs. For more information, see www.hhs.gov


HMO (Health Maintenance Organization)
Prepaid health plans for which a premium is due each month. The HMO covers your cost of care to see a doctor within their working network at pre-negotiated rates. You are required to choose a primary care physician who takes care of you and makes referrals to any specialists you may need. If you, as an HMO member, do not use the doctors, hospitals and clinics that do not participate in your plan’s network, you may be required to pay the cost of those medical services.


HSA (Health Savings Account)
Like it’s precursor MSA, or Medical Savings Account, the HSA is a two-component health plan consisting of a Tax-Deductible, high deductible Catastrophic health insurance plan, and a Tax-Free claims expense reimbursement and Tax-Deferred Savings Plan.


Lifetime Maximum
The maximum percentage of benefits available to a member during their lifetime, in which, all benefits served are subject to this limit unless stated as unlimited.


Out-Of-Pocket Maximum
The highest amount of money you will pay in a year for deductibles and coinsurance plus regular premiums.


Point-Of-Service (POS) Plan
A certain managed care plan combing features of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). You may choose whether to go to a network provider and pay a flat dollar amount or to an out-of-network provider and pay a deductible and/or coinsurance charge


Pre-existing Condition
A health problem that existed or was treated before your insurance became in effect. Most health insurances have a pre-existing condition clause that describes under what conditions they will cover medical expenses that relate to a pre-existing condition.


PPO (Preferred Provider Organization)
A network of health care providers that offers medical services to health plan members at a discounted cost. PPO members usually make their own decisions about their health care instead of going through a primary care physician like an HMO member. The costs to use physicians within the PPO network are less than using a non-network provider.


Premium
The amount you must pay in exchange for health insurance coverage.


Primary Care Physician
Under a health maintenance organization (HMO) or point-of-service (POS) plan, a primary care physician is often the first contact for health care. It is usually a family physician, internist, or pediatrician. A primary care physician makes referrals to specialists if necessary.


Provider
Any person (doctor or nurse) or institution (hospital, clinic, or laboratory) which is certified, that provides medical care to the public.


Well-Child Care
Well –child exams and routine immunizations and lab tests through 2 years of age. Deductible does not apply.


Learn more about Montana health insurance
Read why you should choose Tattory Insurance for your Montana medical insurance needs.