Terminology
What is surcharge?
The Vendor who handles both our individual and group Dental policies
What is United Concordia?
The timeframe in which an individual member can make changes to their policy.
What is Open Enrollment Period?
When an insurance policy removes coverage to a certain body part or body system (ex. conditions of the right knee)
What is an exclusion?
Vendor who deals with life policies, critical care policies, AD&D policies, etc.
What is Usable?
If the member has one of these, then they can make changes outside of the OEP
What is a Qualifying Life Event?
The amount a member must pay before insurance pays anything.
What is a deductible?
Vendor who handles ABCBS pharmacy benefits (also known as our "pharmacy benefit manager")
What is Caremark?
In order to decrease a deductible, a member would complete this.
What is an Underwriting Change Form?
When a member meets this, the insurance company will pay most things at 100% of allowable charges.
What is Out of Pocket?
Vendor who handles both individual and group stand-alone Vision
What is VSP?
To remove a member from the plan, a member would complete this.
What is a Non-Underwriting Change Form?
This is the percentage the member and the insurance company pays once a member meets their deductible
What is coinsurance?
Vendor who handles Mental Health AND Autism benefits
What is New Directions Behavioral Health?
A member would have to complete this to have their policy reviewed for a surcharge or exclusion removal.
What is an Underwriting Change Form?