DescriptionDefinition for Terms and Conditions

Definition for Terms and Conditions

Balance Billing – As defined in 42 CFR § 422.2

Blue Plan – Any one of the health plans operating under a license from the BlueCross BlueShield Association.

Cost Sharing - as defined in 42 CFR § 422.2

Covered Services – Medically necessary health care services and supplies delivered to or provided for BlueAdvantage Members for which benefits are available under the terms of the Member’s benefit plan.

Emergency and Urgently Needed Services – As defined in 42 CFR § 422.113(b)

Medicare Allowable Amount – The fee that Medicare establishes as reasonable for a covered medical service. 

Member – A person who is eligible to receive covered services under a BCBST BlueAdvantage or BlueAdvantagePlus Plan.

Original Medicare - As defined in 42 CFR § 422.2

Provider - As defined in 42 CFR § 422.2

Page Modified:May 21, 2012