Annual
Deductible
Traditional Medical Coverage:
Amount of medical expenses that must be paid by the member before plan
coverage begins. On some plans, the deductible is waived for certain
services such as Well-Child and adult office visits. The first two (2)
members of an enrolled family to satisfy their individual deductibles in
full will satisfy the deductible for the entire family.
Short-Term Medical Coverage:
Amount of medical expenses that must be paid by the member before plan
coverage begins. The deductible is waived for accidental injuries. The
first two (2) members of an enrolled family to satisfy their individual
deductibles in full will satisfy the deductible for the entire family.
Dental Coverage:
Amount of dental expenses that must be paid by the member before plan
coverage begins. |
Annual Maximum
The maximum amount of benefits available to you during a year. |
Annual
Out-of-Pocket Maximum
Traditional Medical Coverage:
The maximum amount you will pay for your share of medical expenses
during a calendar year (including coinsurance, copayments and
deductibles to in- or out-of network providers). After you reach this
amount, the plan pays 100% of your medical expenses. The first two (2)
members of an enrolled family to satisfy their out-of-pocked maximums
will satisfy the requirement for the entire family.
Short-Term Medical Coverage:
The maximum amount you will pay for your share of medical expenses
during a calendar year (including coinsurance, co-payments and
deductibles to in- or out-of network providers). After you reach this
amount, the plan pays 100% of your medical expenses. |
Benefit Amount
The amount payable to a beneficiary in the event of the insured's death. |
Choice of
Dentist
The dental plan offers members the option of going to any dentist they
choose. It is to the members benefit to use a participating plan
dentists because we have negotiated the amounts that plan members are
charged. If members choose a non-participating dentists will they will
experience greater out of pocket expenses. |
Routine Cleaning
Cleaning of the teeth when there is no gum disease, also known as a
prophy or prophylaxis. This includes removal of plaque, tartar and
stains from the tooth surface above the gum line. Time to perform this
procedure varies with the amount of plaque, tartar or stains present and
the length of time since the last cleaning.
Child with fluoride
A teeth-cleaning that includes an application of a fluoride gel or
liquid that helps to prevent decay. |
Crown
Stainless Steel:
A crown made of stainless steel material is prefabricated and usually
used as a temporary measure in baby teeth.
Except Stainless Steel:
A crown is the covering put on a tooth after extensive decay is removed
when not enough tooth structure is left to restore it with a filling.
Crowns are sometimes used to improve the esthetics of a tooth or teeth
(cosmetic) and usually are not covered if there is no decay. |
Daily Premium
Is the basis for how the member calculates total premium, based upon the
amount of days selected. |
Dental Coverage
The policyholder and Blue Cross agree to share the expense of unknown
future dental care. |
Drug Benefits
Traditional Medical Coverage:
Coverage for medications prescribed by a physician, not sold over-the
counter. Most plans provide immediate coverage for generic drugs while
brand name drugs are subject to a deductible.
Short-Term Medical Coverage:
Coverage for medications prescribed by a physician, not sold over-the
counter. Prescriptions must be filled in a retail pharmacy. Plans
provide immediate coverage for generic drugs while brand name drugs are
limited to a maximum of $500 per insured. |
Emergency
Services
Traditional Medical Coverage:
Appropriate treatments for a sudden, serious and unexpected acute
illness, injury, psychiatric or medical condition. Benefits are provided
for Emergency Room and hospitalization.
Short-Term Medical Coverage:
Appropriate treatments for a sudden, serious and unexpected acute
illness, injury, psychiatric or medical condition. Benefits are provided
for Emergency Room and hospitalization. Accidental injuries are not
subject to the deductible. |
Extraction
The process or act of removing a tooth when it is completely erupted and
there are no complications. |
Filling
Removing decay and replacing one or more surfaces of a tooth structure
by using materials such as metal, alloy, resin or porcelain. |
Gingivectomy
The removal of gum tissue in one of the 4 sections of the mouth known as
the upper right, upper left, lower right or the lower left. |
Hospital
Inpatient/Outpatient
Traditional Medical Coverage:
Charges for hospital facilities used for both inpatient and outpatient
procedures. After you meet the plan's deductible, then you share a
percent of these. You save money by choosing a Preferred Participating
Hospital.
Short-Term Medical Coverage:
Charges for hospital facilities used for both inpatient and outpatient
procedures. After you meet the plan's deductible, then you share a
percent of these. You save money by choosing a Preferred Participating
Hospital. |
HSA Compatible
Compatibility with tax-deferred savings account: Indicate a high level
of importance if you are eligible for and would like to participate in a
Healthcare Savings Account (HSA).
HSAs are designed to help individuals save for qualified medical
expenses on a tax-free basis. An HSA combines a savings account with a
High Deductible Health Plan (HDHP). BCC offers the HDHP.
Typically anyone who is not entitled to Medicare and cannot be claimed
as a dependent on another person's tax return can qualify for an HSA but
must have a qualified High Deductible Health Plan and no other similar
health insurance. |
Maternity
Traditional Medical Coverage:
Includes pre-natal and post-natal doctor visits, hospital services in
connection with pregnancy, physician services for normal delivery,
cesarean section and complications of pregnancy as well as routine
nursery care for a newborn.
Short-Term Medical Coverage:
Not a benefit under Short-Term Medical coverage |
Member Costs
Member is financially responsible for anything above discounted fee in
network or anything above the fixed fee for out of network benefits. |
Office Visits
Traditional Medical Coverage:
Visits made to a physician's office for one or more of the following
services: examination, information gathering, diagnosis and treatment
plan.
Short-Term Medical Coverage:
Visits made to a physician's office for one or more of the following
services: examination, information gathering, diagnosis and treatment
plan.
Dental Coverage:
Visits made to the dental office every time you go. |
Oral Exams
Periodic
An examination performed on a returning patient to determine any changes
in the patient's dental and medical health condition since the patient's
last visit.
Comprehensive
A thorough examination of the oral cavity's hard and soft tissues. This
would include the evaluation and recording of a patient's dental and
medical history and general health assessment. |
Orthodontic Care -
Adult
The act of straightening an adult set of teeth. |
Orthodontic Care -
Child
The act of straightening a child set of teeth. |
Orthodontic Care -
Retention
The process of using an appliance to stabilize teeth following active
orthodontic treatment. |
Partial Denture
A removable denture that replaces some missing teeth, top or bottom. |
Physician Choice
Traditional Medical Coverage:
Determines whether or not you can go directly to a specialist (PPO
plans) or whether referrals must be coordinated by your primary care
physician (HMO plans). There are 42,000 doctors and 440 hospitals in our
PPO network. You can visit any physician under the PPO plans but you
save money by staying within the network.
Short-Term Medical Coverage:
There are 42,000 doctors and 440 hospitals in our PPO network. You can
visit any physician under the PPO plans but you save money by staying
within the network. |
Plan Fit
The degree to which a plan matches your preference profile. The higher
your percentage the better your preferences match the plan. |
Plan Name
The name of the viewed plan. |
Plan Type
Traditional Medical Coverage:
The type of policy, we offer several: Preferred Provider Organization (PPO),
Exclusive Provider Organization (EPO) and Health Maintenance
Organization (HMO). In general, the wider your choice of doctors and
hospitals, the higher your costs will be.
Short-Term Medical Coverage:
The Short-Term Preferred Provider Organization (PPO) is one of the
largest networks in the state. You can go to any provider but save money
by using network doctors and medical facilities. You decide the length
of coverage from a minimum of 30 to a maximum of 185 days.
Term-Life Coverage:
Individual term life insurance.
Dental Coverage:
Participating Provider Product |
Pontic
The term used for an artificial tooth on a fixed bridge. |
Premium
Monthly Premium:
Traditional Medical Coverage:
The monthly payment you make to Blue Cross of California to maintain
your medical coverage, based on your age, location, and plan selection.
The more costs you are willing to share when you visit a health care
provider, the lower your premium will be.
Term Life Coverage:
The monthly payment you make to Blue Cross of California to maintain
your term life coverage, based on the insured's current age and life
benefit amount.
Dental Coverage:
The monthly payment you make to Blue Cross of California to maintain
your dental coverage.
Total Premium:
After you determine the length of coverage and plan you want, pricing is
based on a per member per day rate. The entire amount is due at the time
of application. |
Premium Details
Calculated based on the insured's current age and Life benefit amount. |
Preventive
Care - General
Short-Term Medical Coverage:
Access to HealthyCheck screenings for members age 7 to adult.
Traditional Medical Coverage:
Specific benefits for care intended to prevent serious medical
conditions through early detection and treatment, including "Well
Baby/Child Care" for infants up to age 6. At a minimum, our plans
provide benefits for routine mammogram, Pap and PSA tests as well as
access to HealthyCheck screenings for members age 7 to adult. |
Professional
Services
Traditional Medical Coverage:
Include x-rays, lab work, and any inpatient or outpatient services of a
surgeon or anesthesiologist. These charges could be required in addition
to an office visit or an inpatient or outpatient hospital stay.
Short-Term Medical Coverage:
Include x-rays, lab work, and any inpatient or outpatient services of a
surgeon or anesthesiologist. These charges could be required in addition
to an office visit or an inpatient or outpatient hospital stay. |
Removal of
Impacted Tooth
Soft Tissue
Removal of an unerupted tooth in which biting surface of the tooth is
covered by soft tissue.
Partial Bony
Removal of an unerupted tooth in which biting surface of the tooth is
covered by soft tissue.
Complete Bony
Removal of an unerupted tooth in which most or all of the crown of the
tooth is covered by bone. |
Root Canal
Anterior
Removal of dead or dying nerve of a tooth located in the front of the
mouth. The space created is then filled with an endodontic filling
material. This procedure often involves more than one office visit.
Bicuspid
Removal of dead or dying nerve of the tooth with two cusps and filling
the space created with an endodontic filling material. This procedure
often involves more than one office visit.
Molar
Removal of dead or dying nerve of the tooth used for grinding. These
teeth are located in the back of the mouth and having large crowns and
broad chewing surfaces. The space created is then filled with an
endodontic filling material. This procedure often involves more than one
office visit. |
Scaling/Root
Planning per Quadrant
Indicated for patients with gum disease, and used as a treatment in some
stages of the disease and as a pre-surgical step in other stages. It
includes removal of plaque, tartar and stains from the crown of the
teeth and microbial flora, bacterial toxins, tartar, and other debris on
the root surface and in the tooth pocket. Some soft tissue removal
occurs. |
Sealant
Application of acrylic placed over the biting surface of an unrestored
permanent molar tooth to prevent decay. |
Short-Term
Medical Coverage
Provides a minimum of 30 to a maximum of 185 days of non-renewable
medical coverage. |
Surgical
Extraction
An extraction that requires the dentist to cut the gum and sometimes the
bone to remove the tooth. There are always sutures when a surgical
extraction is performed. |
Term Life
Coverage
A type of low-cost, life insurance that only pays benefits if the
insured dies during the specified period of time. Unlike whole life
insurance, term life insurance does not build cash value. |
Tobacco User
Tobacco usage is defined as the use of any type of tobacco or
nicotine-containing item including (but not limited to) the following
forms: cigarettes, cigars, snuff, chew, patch, gum or lozenges. |
Topical Fluoride
An application of a fluoride gel or liquid that helps to prevent decay |
Traditional
Medical Coverage
Traditional plans include basic hospital, major medical and H.S.A
compatible plans. As opposed to short-term coverage, traditional medical
coverage stays in effect as long as the premium is paid. |
X-ray
A diagnostic tool used by dentists to detect tooth decay, abscesses and
other dental diseases. |