- 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.
An ethical principle which, when applied to managed care, states that each member should be treated in a manner that respects his or her own goals and values and that MCOs and their providers have a duty to promote the good of the members as a group.4
Industry:Health care
A healthcare benefit arrangement designed to supply services at a discounted cost by providing incentives for members to use designated healthcare providers (who contract with the PPO at a discount), but which also provides coverage for services rendered by healthcare providers who are not part of the PPO network.
Industry:Health care
A rule which states that employees who are injured on the job are entitled to workers' compensation benefits, but they cannot sue their employers for additional amounts.
Industry:Health care
A law which requires health plans that offer medical and surgical benefits for mastectomy to provide coverage for reconstructive surgery following mastectomy.
Industry:Health care
The process an MCO uses to determine which benefits or the level of benefits that will be offered to its members, the degree to which members will be expected to share the costs of such benefits, and how a member can access medical care through the health plan.
Industry:Health care
A prepaid payment or series of payments made to a health plan by purchasers, and often plan members, for medical benefits.
Industry:Health care
The MCO committee responsible for handling issues related to overall organisational policy, including lines of business and employment policies.
Industry:Health care
A state-mandated insurance programme that provides benefits for healthcare costs and lost wages to qualified employees and their dependents if an employee suffers a work-related injury or disease.
Industry:Health care
Actual practices, in use by qualified providers following the latest treatment modalities, that produce the best measurable results on a given dimension.
Industry:Health care
