A type of payment and healthcare delivery model that ties reimbursement of providers to quality metrics to encourage collaboration among participating providers and with the goal to reduce costs and improve the quality of care provided to assigned patients.

A healing practice that does not fall within traditional medicine, such as acupuncture or massage therapy.

Healthcare services provided on an outpatient basis where the patient’s procedure and stay in the facility are completed on the same day.

Benefit coverage that complements health plan coverage, such as dental, vision, or life insurance; also referred to as specialty benefits at Blue Shield.

A percentage of the cost for covered services that a member pays under the health plan.

A federal law that, among other things, requires an employer to offer continuation coverage to certain employees and their dependents whose eligibility for coverage under the group health plan has terminated.

The combination of a financial account with a high-deductible health plan, which are sometimes referred to as account-based health plans. The financial accounts, such as health savings accounts (HSAs), health reimbursement accounts (HRAs), and flexible spending accounts (FSAs), are designed to provide consumers with greater control over their healt [..]

A fixed dollar amount that a member pays for covered services under the health plan.

A financing arrangement through deductibles, coinsurance, or copayments that a member covered by a health plan is responsible for paying when they access covered services.

The benefits covered under the health plan, as defined in the Evidence of Coverage or policy.