Glossary

As you explore our site, you may come across an unfamiliar word or term. We've developed a glossary that we hope will help you.

A (10) B (6) C (17) D (8) E (9) F (5) G (3) H (10) I (7) L (1) M (5) N (6) O (6) P (20) Q (1) R (3) S (5) T (1) U (2) W (2)
Participant agreement

ASO Benefit description, non-group contract, insured group certificate or other coverage document that links the Primary Member to benefits.

Physician services

Healthcare services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.

Plan

A benefit your employer, union or other group sponsor provides to you to pay for your healthcare services.

Point-of-Service (POS)

A prepaid health plan or insurance program that offers the convenience and comprehensive coverage of a managed benefits program by working with a primary care physician for maximum benefits, but also allowing a member to self-refer at a lower payment level of benefits as with the flexibility of a traditional benefits program. Sometimes referred to as self-referred option (SRO).

Policyholder

The person or entity to which the insurance contract has been issued is a member of BCBSKS and is entitled to vote in person or by proxy at meetings of policyholders.

Policyholder meeting

An annual meeting of policyholders held on the second Thursday in May of each year at 8:30 a.m. at the corporation’s principal place of business at 1133 SW Topeka Blvd., Topeka, KS, or at such other place as the Chairman of the Board of Directors might designate in a notice of meeting given to policyholders. Printed notice shall be sufficient notification.

Pre-certification

The process of deciding whether or not BCBSKS will cover a specific service. Check the health plan carefully. Certain procedures, like surgery, require pre-certification. This means the member needs to check with BCBSKS to see if the service is covered before it is received.

Pre-Existing Condition

An injury or illness that is evident before the effective date of the contract. Many health plans do not cover pre-existing conditions. Or, they have a waiting period before the member can receive benefits for them. For example, you hurt your knee playing football a couple years ago and had to have surgery. When you sign up for a new health plan, you'll have to list your knee injury as a pre-existing condition.

Preauthorization

A decision by your health insurer or plan that a healthcare service, treatment plan, prescription drug or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval or precertification. Your health insurance or plan may require preauthorization for certain services before you receive them, expect in an emergency. Preauthorization isn't a promise your health insurance or plan will cover the cost.

Preferred provider

A provider who has a contract with your health insurer or plan to provide services to you at a discount. Check your policy to see if you can see all preferred providers or if your health insurance or plan has a "tiered" network and you must pay extra to see some providers. Your health insurance or plan may have preferred providers who are also "participating" providers. Participating providers also contract with your health insurer or plan, but the discount may not be as great, and you may have to pay more.

Preferred Provider Organization (PPO) plan

A network-based, managed care plan that allows the participant to choose any healthcare provider. However, if care is received from a "preferred" (participating in-network) provider, there are generally higher benefit coverages and lower deductibles.

Premium

The amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly, quarterly or yearly.

Prescription drug coverage

Health insurance or plan that helps pay for prescription drugs and medications.

Prescription drugs

Drugs and medications that by law require a prescription.

Preventive care

Medical and dental services aimed at early detection and intervention.

Primary care physician

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of healthcare services for a patient.

Primary care provider

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of healthcare services.

Primary member

The person identified on the ASO benefit description, non-group contract, insured group certificate or other coverage document.

Provider

A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), healthcare professional or healthcare facility licensed, certified or accredited as required by state law.

Provider discounts

The amount of money contracting healthcare providers deduct from their charge due to contracts between themselves and a health plan.