Blue KC - Health Insurance Basics

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Health Insurance Basics

Make the Most of Your Health Plan - Get to Know Basic Health Insurance Terms.

Blue Cross and Blue Shield of Kansas City (Blue KC) is committed to helping you understand your health insurance, so you can make more informed decisions about your health. That’s why we’re providing you with videos you can watch that explain health insurance basics like copayments and coinsurance. You can also look up health insurance terms in the Blue KC Glossary. Video and glossary topics include:

Learning more about deductibles
Understanding your explanation of benefits
Reviewing definitions of terms such as allowable charges

Topics

Changing Insurance Plans

From marriage… to receiving a promotion, certain "life events", otherwise known as an IRS “change of status” allow you to modify benefit selections outside of your company’s annual open enrollment period.

Qualified changes of status include...

Copay

When you visit a healthcare professional in your insurance group, you typically have to provide personal information, your medical history, and you may also have to make a payment before you leave the office.

This money is known as a co-payment. Your health insurance policy determines this dollar amount, which you are required to pay for certain healthcare services...

Deductible

Your deductible is the fixed dollar amount that you must pay before your health insurance plan pays its portion of your medical bills.

For example, if you have a health insurance plan with an annual deductible of $200 and an 80% coverage level, you must pay $200 worth of the medical bill before...

EOB

It looks like a bill, feels like a bill, but an explanation of benefits is not a bill. If you have a health plan, it’s the statement you get from your insurance company after you receive services from a healthcare provider.

The EOB lists several things including the services you received, the amount of cost your plan covers...

HDHP

High Deductible Health Plan or HDHP is a type of health insurance plan. It is characterized by higher annual deductibles and lower premiums than traditional health plans like PPO's.

HDHP's do not cover healthcare related expenses until minimum deductible amounts are met. However, once met, you're often covered 1-hundred percent for...

HMO

You want to stay healthy and keep your healthcare expenses low. Who doesn't? An important part of wellness is knowing how to utilize the services offered by your Health Maintenance Organization, or HMO. With an HMO, you pay a set fee, usually monthly or yearly. Because costs are fixed to members in advance, preventive care is key...

HSA

A Health Savings Account, or HSA, allows you to pay for qualified medical expenses with tax-free money.

To qualify for an HSA, you must have a high deductible health plan, otherwise known as an HDHP. You will need to work with a qualified HSA trustee when you set up...

Insurance Premiums

A premium is the money a person pays, typically each month, to maintain his or her insurance policy.

Insurers may decide how much to charge you in premiums based on their prediction of potential costs of providing coverage. For example, when you apply for coverage, an insurer may ask about your current health status...

In/Out Network

In many healthcare plans, such as a PPO or an HMO, an in-network provider is a doctor, hospital, or other healthcare professional that has an agreement with your insurance company to provide services to plan members for a set-rate.

This in-network provider, sometimes called a preferred care provider, specifically accepts your insurance...

Open Enrollment

Open enrollment, also known as annual enrollment, is a period of time usually but not always occurring once per year, when employees of U.S. companies and organizations may make additions, changes or deletions to their elected fringe benefit options.

In most cases, employees can only make changes...

PPO

A Preferred Provider Organization or PPO is a type of healthcare coverage an employer may offer its employees.

In a PPO, a group of doctors, hospitals and other healthcare professionals have contracted with an insurance company or a third-party administrator to provide their services to PPO customers at a discounted rate...

Pre Existing Condition

In general, the term pre-existing condition refers to a health condition that was diagnosed or treated before you enrolled in or purchased a health insurance plan.

An exclusion period or pre-x wait period is the length of time that claims will not be covered for that health condition under your new plan. The exclusion period typically...

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Related Information

Healthcare Glossary Look up terms related to health insurance.

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The glossary contains generalized definitions and examples related to healthcare coverage. The terms of your specific certificate or contract are binding and supersede any definitions and examples.

If you have questions contact Customer Service.

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