Glossary of Health Insurance Terms

National Association of Medical Equipment Suppliers.

A business who has employees in more than one Blue Cross and Blue Shield Plan area that provides consistent coverage for all of their employees. Special arrangements are made with these businesses to maintain equal benefits throughout each Blue Cross and Blue Shield Plan that would have the business' employees in the Plan's jurisdiction.

See "Blue Cross and Blue Shield Association."

A private, not-for-profit organization that assesses and reports on the quality of the nation's managed care. Their mission is to provide information that helps purchasers of managed health care to make informed health care purchasing decisions.

The numeric identifier of the medicine being administered. This identifier is listed on the packaging material of the medicine.

See "National Committee for Quality Assurance."

See "National Drug Code."

A defined group of providers, typically linked through contractual arrangements with the insurance company or payor.

A "closed" network is one in which patients are not allowed to access non-network providers without the service being considered non-covered.

An "open" network allows access to other providers at some cost to the patient, this is referred to at BCBSKS as SRO.

A Doctor of Chiropractic who has signed the BCBSKS "Kansas Chiropractic Network" -KCN provider agreement.

A provider of eye care services who has signed the Boeing Vision Network -BVN provider agreement(s).

An employee group that has contracted with us to use BCBSKS allowance for their claims utilizing our CAP Network and MAPs.

Any person or entity that has signed a contract with BCBSKS to participate in a specific program.

Coverage that pays for losses associated with a motor vehicle accident regardless of the fault of the driver.

See "Non-contracting provider."

A provider of healthcare services to which BCBSKS has offered a contract and the provider has elected not to sign the contract. Reimbursement for services rendered by a non-contracting provider is made to the patient even when the provider has submitted the claim. The patient may not assign the payment to the non-contracting provider.

The patient is responsible for amounts in excess of the MAP. The provider may collect for all services at the time of service. This does not apply to those providers that we do not contract with their provider type, i.e. registered nurses, licensed practical nurses, opticians or hearing aid dispensers

Medical care for which benefits are not provided under the patient's contract. Non-covered services are the patient's financial responsibility. The contracting provider may collect for these services at the time they are rendered. These should not be confused with services that are determined to be not medically necessary, experimental or investigational. The contracting provider may not collect for these unless the patient has signed a waiver prior to the service being rendered.

See "Non-contracting provider."

See "Non-contracting provider."

A giver of health care services who is eligible for reimbursement from BCBSKS but BCBSKS does not contract with them.

See "Unlisted procedure."

See "Unlisted Procedure."