Old man and boy fishing together on river for fun.

Glossary

An amount we use to calculate our payment of covered services. This amount will be based on either the Contracted Amount for In-network Providers or the Out-of-network Allowance.
When you can sign up for, change, or disenroll from a Medicare Advantage, Part D plan or Medicare. The AEP runs from October 15 to December 7 each year.
Arrangement with provider for patient and payment value.
BlueHealth Advantage is the umbrella name for our wellness programs. BlueHealth Advantage is used both internally for our employees as well as an external program for our employer groups. Visit BlueHealth Advantage for wellness resources that are accessible for everyone.
The percentage of the bill you pay after your deductible has been met.

Coordination of benefits is the process used when a member has two health insurance plans. This process allows the two plans to work together getting you the most out of your coverage. One plan becomes your primary plan, paying your claims first. The second plan becomes your secondary plan, which may pay toward the remaining cost, depending on the plan. Understanding which plan is your primary and which plan is your secondary is important to help prevent delays in claims processing.

Members may complete this form online on myNebraskaBlue.com or by downloading the Coordination of Benefits Form.

A fixed amount you pay when you get a covered health service. For example, a doctors office visit.
The amount you pay for health services each calendar year before your insurance begins to pay.
Regulatory organization for the insurance industry within the state.
Any covered services received in a hospital emergency room setting.
Document provided to members after they receive care that shows the covered amount of their services and what they owe.
Combined with a high-deductible health plan (HDHP), a health reimbursement arrangement (HRA) is funded by an employer to assist the employee in paying for health care expenses. Any unused balance at the end of the year may be rolled over to cover future expenses. Health care benefits are costly and an HRA is an excellent tool to help an employer manage the rising costs of health care while still giving employees the coverage they need and deserve.
A health plan that satisfies certain requirements with respect to deductibles and out-of-pocket expenses. Specifically, for self-only coverage, an HDHP has an annual deductible of at least $1,000 and annual out-of-pocket expenses required to be paid (deductibles, co-payments and other amounts, but not premiums) not exceeding $5,000. For family coverage, and HDHP has an annual deductible of at least $2,000 and annual out-of-pocket expenses required to be paid not exceeding $10,000. In the case of family coverage, a plan is an HDHP only if, under the terms of the plan and without regard to which family member or members incur expenses, no amounts are payable from the HDHP until the family has incurred annual covered medical expenses in excess of the minimum annual deductible. Amounts are indexed for inflation and 2005 amounts are shown. A plan does not fail to qualify as an HDHP merely because it does not have a deductible (or has a small deductible) for preventative care (e.g., first dollar coverage for preventative care). However, except for preventative care, a plan may not provide benefits for any year until the deductible for that year is met.
A program of care provided for persons diagnosed as terminally ill, and their families.
A health savings account (HSA) is a tax-advantaged savings account that can be funded by individuals whose only health care coverage is a high deductible health plan (HDHP). An HSA is an alternative way for you to pay for your qualified health care expenses and save for future qualified health care expenses on a tax-free basis. Expenses such as out-of-pocket costs for office visits, prescription drugs, dental expenses and laboratory tests may be paid for from your HSA.
Care you receive that requires admission to a hospital.
A provider contracted by your insurance company to accept an agreed upon payment for covered services.
Services that are not payable under the contract.
The window of time you can purchase or renew your health insurance.
A term for providers that aren’t contracting with your insurance plan. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)
Your expenses for medical care that aren’t reimbursed by your plan, including deductibles, coinsurance, and copayments for covered services.
Care you receive at a hospital or health care facility without being admitted.
A health benefit program that offers the highest level of benefits to members when they obtain services from any physician or hospital designated as a PPO provider. Substantial benefits still are provided when the member obtains care from another provider of choice. No primary care physician gatekeeper/referral is required for access to PPO providers. The PPO provider network includes, at a minimum, hospitals and physicians and may include, at a minimum, hospitals, physicians and other health care providers.
The amount your charged each month for your health insurance plan.
Routine health care that includes screenings and check-ups to prevent illness, disease, or other health problems.
A physician who has a majority of his or her practice in the fields of internal or general medicine, obstetrics/gynecology, general pediatrics or family practice.

The time outside of the open enrollment period when you can enroll or make changes to your health plan if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).


A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.