Blue Cross and Blue Shield Key Terms

Ensure your health insurance by understanding Blue Cross Blue Shield key terms

When it comes to health insurance, Blue Cross Blue Shield, also called BCBS or BC/BS, dominates the industry. Being familiar with key terms can help you determine what type of policy to get; the best premium, or rate, to pay; the best deductible to choose; and the best program for your needs. Before you start shopping for the best policy, get familiar with the key terms used by BCBS so you'll understand the lingo your broker is using.

BCBS Association

In order to offer national insurance coverage, the company utilizes the BCBS Association, which includes 39 independent BCBS companies. Each company works to uphold the standards for BCBS while offering top-quality health insurance.

Blue365

Blue365 is a special program operated by BCBS. The insurance company designed the program as a way to reward members who opt to live a healthy life style. It also aims to provide educational information to members.

Anthem

Anthem, often called Anthem BCBS, is the largest provider of BCBS health insurance. While the majority of Anthem brokers offer BCBS, not all of Anthem's affiliates offer it.

Broker

An insurance broker who works with BCBS is a licensed professional who is qualified to give you advice regarding the products and services offered by the company. In some cases, a broker will negotiate the terms of the policy for the consumer.

HMO

People with a health maintenance organization (HMO) plan must use the doctors approved by BCBS. These doctors, called in-network doctors, have contracted rates with BCBS for services. When you have an HMO, BCBS only covers the cost of your medical bills at the set percentage rate if you use an in-network doctor. Any out-of-network visits require you to pay for the medical bills without BCBS reimbursement.

PPO

Preferred provider organizations (PPOs) allow you more options in regard to the doctors you choose to visit. With a PPO, your insurance will cover treatment, usually at reduced percentage, if you decide to go with an out-of-network doctor or facility. The benefit to this is that you can get treatment from any doctor anywhere and know that your insurance will pay a portion of the medical bills.

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