To help you better understand our plans and your coverage, here are a few definitions for frequently used health care terms.

Please e-mail me at kimberly_patterson@bcsd.org if you would like other terms to be added.

Primary Care Physician (PCP): A doctor who serves as your health care manager and coordinates virtually all of the health care services you routinely receive.

Referral: Instructions provided by a PCP for specialty care. Most plans do not require referrals.

In-Network Coverage: The coverage available when you receive services from a provider who participates in your health plan.

Out-of-Network Coverage: The coverage available when you receive services from a provider who does not participate in your health plan.

Out-of-Area: Describes when you receive services while outside the geographic service area of your health plan.

Copay: A dollar amount due at the time you receive certain services. A typical example would be an office visit copay due when visiting your physician's office for treatment.

Allowed Amount: The maximum amount your health plan will pay for a specific service.

Coinsurance: A cost sharing method that requires you pay a portion of the allowed amount for certain medical services.

Deductible: A set dollar amount you pay for covered services you receive before your insurer will make a payment.

Out-of-Pocket Maximum: The maximum amount of deductible and coinsurance payments that you will pay for heath services each calendar year.

Balanced Billing: If you receive services from a nonparticipating dentist, Excellus BCBS will pay according the the BCBS Schedule of Allowances. Any amount the dentist charges for that service above the BCBS Schedule of Allowances may be billed directly to the member.