- Industry: Health care
- Number of terms: 4240
- Number of blossaries: 0
- Company Profile:
The Blue Cross Blue Shield Association (BCBSA) is a federation of 39 separate health insurance organizations and companies in the United States. Combined, they directly or indirectly provide health insurance to over 100 million Americans.
Employer group that has offices or branches in more than one location, but offers uniform coverage of benefits to all of its employees.
Industry:Health care
The separation of a medical service (or a group of services) from the basic set of benefits in some way.
Industry:Health care
In the context of a pharmacy benefit management (PBM) plan, a programme that requires physicians to obtain certification of medical necessity prior to drug dispensing. Also known as a medical-necessity review. See also precertification.23
Industry:Health care
A cost containment programme that recovers money where primary responsibility does not exist because of another group health plan or contractual exclusions. Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance.
Industry:Health care
Individual medical expense insurance policies sold by state-licensed private insurance companies.
Industry:Health care
A law which prohibits group health plans from applying more restrictive annual and lifetime limits on coverage for mental illness than for physical illness.
Industry:Health care
An HMO that contracts with more than one group practise of physicians or specialty groups.
Industry:Health care
A law which specifies that group health plans or group healthcare insurers cannot mandate that hospital stays following childbirth be shorter than 48 hours for normal deliveries or 96 hours for caesarean births.
Industry:Health care
A type of physician-hospital organisation that is available to all of a hospital's eligible medical staff.
Industry:Health care
An HMO in which any physician who meets the HMO's standards of care may contract with the HMO as a provider. These physicians typically operate out of their own offices and see other patients as well as HMO members.
Industry:Health care
