Health Insurance Glossary
- Balance Billing
- Out-of-network providers can charge more for their services. If you see an out-of-network provider, you may be responsible for paying the difference between their price (actual charge) and the maximum amount your insurance plan will pay (allowed amount or allowed benefit).
[HINT]: To keep your costs lower, it’s best to use in-network providers as much as possible. CareFirst in-network providers have agreed to accept the allowed amount as payment in full and will not balance bill you.
- You see an out-of-network provider for a particular covered service.
- The provider’s actual charge for that service is $100.
- But your insurance plan only pays the allowed amount, which is a maximum of $75 for that service.
- The provider can bill you for the remaining $25—this is balance billing.
- Basic Coverage
- Hospital and medical coverage only -- does not include extended medical, major medical, dental and rider coverage. Also includes Medicare Part A and B coverage, exclusive of supplementary coverage.
- Behavioral Health Services
- See Mental Health Services.
- Any service or supply covered by the member's health insurance plan or contract.
- Benefit Period
- A period of time for which covered services (or benefits) are eligible for payment.
- Benefit Reduction Amount
- The amount subtracted from allowed benefits under certain cost-savings programs administered by CareFirst.
- Benefits Administrator
- Individual responsible for handling employee health benefits for the employer. See Group Administrator.
- An HMO plan offered by CareFirst BlueChoice, Inc., an independent licensee of the Blue Cross Blue Shield Association.
- Brand-name Drug
- A prescription drug that has been patented and is only available through one manufacturer.