Blue Cross Blue Shield of California Insurance Terminology

Understanding terminology when it comes to Blue Cross Blue Shield of California can be tricky and tremendously confusing. For example what is a co-payment and what is a deductible? In order to completely understand a Blue Cross Blue Shield of California policy you must understand health insurance terms. Let’s take a closer look.

Co-insurance comes about in a traditional fee-for-service Blue Cross Blue Shield of California plan. It is the amount a person needs to pay for their health care after they have paid their annual deductible. Co-insurance is generally expressed by way of a percentage figure. In most cases Blue Cross Blue Shield of California will pay 80 percent of an insurance claim while the insured member pays 20 percent.

A co-payment is a form of sharing medical costs between the insurance company and the customer. A flat fee must be paid every time you require a medical service of any kind, such as paying five dollars or ten dollars for visiting the doctor.

Most Blue Cross Blue Shield of California insurance plans, whether they are traditional fee-for-service, HMOs or PPOs do not cover all medical and health services. Some insurance plans cover prescription drugs while others do not. Covered expenses are the expenses that the insurer agrees to pay for plain and simple.

A deductible is the amount of money you are required to pay to Blue Cross Blue Shield of California in order to cover any and all of your medical expenses before the insurance will begin paying for any of your medical services.

Exclusions on a Blue Cross Blue Shield of California means the circumstances under which the insurance company will not make certain benefits available to its members. Always find this out before you decided on a particular insurance policy.

A health maintenance organization (HMO) is a form of a prepaid health plan that is an excellent choice for those low on funds. In this case the insured member pays a monthly premium and the HMO then goes ahead and pays the member’s visits to the doctor, his or her check ups, laboratory tests, x-rays, hospital stays, emergency care and so on. The member must stay within the HMO in order to be adequately covered.

Managed care is the name that characterizes all HMOs, PPOs and most types of traditional fee-for-service plans. It is a way to manage the cost of high insurance rates and also to manage the use of the medical system.

A premium is paid on a yearly basis with a Blue Cross Blue Shield of California plan but is can also be paid in a lump sum once a year. In this case it is the amount of money either your employer or you as an individual doles out in order to have the privilege of health coverage.