Glossary of Terms
The terms in this Glossary come from the printed Explanation of Benefits (EOB) that FEP members and their dependents receive in the mail. Not all of the terms from that document are currently in use on the MyBlue Customer eService website.
Your Service Benefit Plan coverage limits your out-of-pocket expenses; coinsurance, copayments and deductibles you pay per calendar year. If you reach your catastrophic protection limit within a calendar year, we will pay 100 percent of certain covered out-of-pocket expenses for the remainder of the year. Please note that not all your out-of-pocket expenses will count toward meeting your catastrophic protection limit. See your Service Benefit Plan brochure for more information.
The percentage of the Plan Allowance that you must pay for your care.
The fixed amount of money you pay to the physician, facility, pharmacy, etc. when you receive certain services.
DATE OF SERVICE
The month, day and year you actually received services.
The fixed amount of covered expenses you must incur each calendar year for certain covered services and supplies before we start paying benefits.
The amount paid by another health insurance carrier when you or covered family members have coverage with Medicare or another health benefit plan.
We did not pay for these services. You are responsible for these charges.
The amount used to determine our payment and your coinsurance for covered services or the amount we use to calculate our payment for covered services.
We will reduce your benefit by $500 if no one (you, your physician or the hospital) contacts us to obtain precertification of inpatient hospital services, when required.
The hospital, health care facility, physician or other health care professional who provided services to you.
Each local Blue Cross and Blue Shield Plan can contract with providers in its service area. There are two types of professional contracting providers, Preferred and Participating and two types of contracting facilities, Preferred or Member. If providers do not contract with the Plan, they are considered to be non-participating or non-member.
An explanation of the payment determination for a particular service.
This is the amount the provider has billed.
TYPE OF SERVICE
This is a general description of the service or supply provided.