- 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.
A rating method under which a health plan or MCO divides its members into classes or groups based on demographic factors such as geography, family composition, and age, and then charges all members of a class or group the same premium. The plan cannot consider the experience of a class, group, or tier in developing premium rates. Also known as modified community rating.
Industry:Health care
The hiring of external vendors to perform specified functions, such as data and information management activities, for an MCO.
Industry:Health care
The activities and systems designed to make products or services available so that consumers can buy them.
Industry:Health care
A company that provides administrative services to MCOs or self-funded health plans but that does not have the financial responsibility for paying benefits.
Industry:Health care
A contract under which a third party administrator or an insurer agrees to provide administrative services to an employer in exchange for a fixed fee per employee.
Industry:Health care
The length of time that members must drive to reach a primary care provider, which is typically set at a maximum of 15 minutes for urban areas and up to 30 minutes for rural areas.
Industry:Health care
A pharmacy benefit copayment system under which a member is required to pay one co-payment amount for a generic drug, a higher co-payment amount for a brand-name drug included on the health plan's formulary, and an even higher co-payment amount for a non-formulary drug.
Industry:Health care
A situation in which an MCO's operations are placed under the direction and control of the state commissioner of insurance or a person appointed by the commissioner.
Industry:Health care
A type of outcomes measure related to whether the patient feels completely "better" after treatment or feels improved compared to how he or she felt prior to receiving treatment.
Industry:Health care
The amount of time required to complete a particular member-initiated transaction.
Industry:Health care
