A physician or other medical professional who serves as a group member's first contact with a company health care system
What is Primary Care Physician
100
OTC
What is Over The Counter
100
The charge that BCBSNC determines is reasonable for covered services provided to a member. This may be established in accordance with an agreement between the provider and BCBSNC.
What is Allowed Amount
100
DOB
What is Date Of Birth
100
The amount of time that must pass before a member is eligible to be covered for benefits under the terms of the health benefit plan.
What is Waiting Period
200
A form of cost-sharing in which the policy member must pay a specified percentage of all remaining eligible medical expenses after the deductible has been paid
What is Coinsurance
200
HMO
What is Health Maintenance Orginization
200
The fixed-dollar amount which is due and payable by the member at the time a covered service is provided.
What is Copayment
200
PHI
What is Protected Health Information
200
Pertaining to services received from a hospital or non-hospital facility by a member while not an inpatient
What is Outpatient
300
The specified period of time during which charges for covered services provided to a policy member must be incurred in order to be eligible for payment
What is Benefit Period
300
EOB
What is Explanation of Benefits
300
The approval of specific medical services, prescription drugs, and/or supplies for BCBSNC policy members. Procedures included in the Prior Plan Approval list include high-cost and/or potentially abused services and medications.
What is Prior Plan Approval
300
LOB
What is Line Of Business
300
DIM
What is Diagnostic Imaging Management
400
Services performed by a provider who has not signed a contract with the policy member's health plan to be part of a provider network.
What is Out-of-Network Provider
400
CMM
What is Comprehensive Major Medical
400
A specified amount of covered services, usually expressed in dollars, that is the extent of the Plan's liability per lifetime per member under the certificate
What is Lifetime Maximum
400
DOI
What is Department Of Insurance
400
A non-hospital facility that provides medically related services to patient and their family who are terminally ill.
What is Hospice
500
Pertaining to services received when a policy member is admitted to a hospital or nonhospital facility as a registered bed patient for whom a room and board charge is made.
What is Inpatient
500
COB
What is Coordination of Benefits
500
The person whose name appears on the identification card and who is enrolled according to the records of the Plan.
What is Subscriber
500
DOS
What is Date Of Service
500
The portion of payments for health services required to be paid by the policy member, including co-payments, deductibles, and coinsurance