Blue Cross of California Glossary of Terms

Co-insurance ý Monetary amount you must pay in a point-of-service plan (POS) or preferred provider organization (PPO) after you have paid your deductible. This amount is often a percent of bills you have charged.

Co-payment ý The amount you are required to pay for medical services. Your health care plan takes care of the rest of the remaining charges. For example, you may be responsible for paying $10.00 for an office visit or for a prescription.

Deductible ý Each year, you are required to pay this amount for your medical care before your insurance policy begins to cover your expenses.

Exclusions ý Your policy will not cover these specific conditions or circumstances.

Fee-for-Service ý Payment agreements for your health care that allow the provider to pay for each service.

IPA (Independent Practice Association) ý Group of physicians who collaborate with an HMO to offer services for HMO group members.

Lifetime Maximum ý Each member has a maximum percent of benefits that they can access during their lifetime. All benefits are held to this limit.

MSA (Medical Savings Account) ý This is a personal savings account that is used with an elevated deductible health policy. This account is a tax-advantage that works when you deposit money into this account before taxes for any incidental medical expenses. Qualified expenses would include annual deductibles and co-payments.

Out-of-Pocket Maximum ý The most money you will pay in a given year for deductibles and coinsurance in addition to regular premiums.

Point-of-Service (POS) Plan ý Term refers to a specific managed care plan which combines the features of both an HMO and a PPO plan. You decide whether to go to a network provider and pay a set dollar amount to go outside of the network and pay a coinsurance fee.

Pre-existing Condition ý Health problem that was apparent before your insurance benefits took effect. Most health insurance policies have a stipulation in regards to pre-existing conditions.

Primary Care Physician ý Under either a POS or HMO plan, a primary care physician coordinates all of your health care needs and is your first contact regarding your health care.