Allowable Charge -

The maximum amount the Plan will cover for a particular medical service.

Balance Billing -

The amounts in excess of the Plans Allowable Charges. The plan defines how much a given service is worth - if your doctor/dentist charges more than this, you will pay the difference.

Brand Name Drug -

a drug that has an advertised name. The Plan provides a greater benefit if you choose a "preferred brand drugs" over an "other brand drug."

Coinsurance -

a percentage of the cost for medical expenses, such as doctor's visits, that you are responsible to pay.

Coordination of Benefits -

when you are covered under two medical plans, coordination of benefits is how Blue Cross Blue Shield of Mississippi decides which plan covers your care first.

Co-payment -

a flat fee you pay for certain medical expenses, such as prescription drugs. For example, the current co-payment for generic drugs (after the deductible is met) is $12.

Deductible -

the amount you must pay out of your own pocket each year for medical expenses before the Plan will begin to cover your expenses. For medical care, the Select Coverage deductible is $500 per person (as long as you use in area/in network providers); for prescriptions the deductible is $50. The dental deductible is also $50 for individual coverage.

Dependent -

the husband, wife, or unmarried child(ren) of an enrollee who can be covered under the Plan.

Explanation of Benefits (often referred to as EOB) -

an itemized statement from Blue Cross Blue Shield or Catalyst Rx that lists charges made and the amounts paid or denied as the result of a claim.

Generic Drug -

a drug that has the same chemical ingredients of an advertised brand name drug. The Plan provides greater benefits when you choose a generic drug over a brand name drug when filling a prescription.

In-Network -

when you receive care from a provider that is part of the AHS State Network. Providers who participate in the AHS State Network agree to pre-negotiated fees. You receive a higher benefit if you participate In-Network.

Other Brand Drug -

a brand name drug that is not on the Catalyst Rx preferred drug list.

Out-of-Network -

when you receive care from a physician or facility that is not part of the AHS State Network. You will receive a lesser benefit than if you participate in-network.

Pre-certification -

a review by Intracorp to determine if a scheduled service or admission is medically necessary and meets any notification requirements of the Plan.

Preferred Brand Drug -

a brand name drug that is on the Catalyst Rx preferred drug list. You will receive a higher benefit if you choose the preferred brand drug versus an "other brand drug."

Utilization Review -

the process to determine that your care is medically necessary and that you are receiving the appropriate treatment, for the right length of time, and in the most appropriate setting.