A group of healthcare providers that agrees to deliver coordinated care, meeting performance benchmarks for quality and affordability in order to manage the total cost of care for their member populations.

The Patient Protection and Affordable Care Act (commonly called the ACA) was signed into law in 2010 to address access, quality and cost in the healthcare industry. The Patient Protection and Affordable Care Act was signed into law on March 23, 2010, and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” refers to the final, amended version of the law.

A medical care center that provides a wide range of healthcare services, including preventive care, acute care, surgery and outpatient care, in a centralized facility.

A free-standing center that performs various types of surgery.

The Medicare+Choice delivery option that includes health maintenance organizations, or HMOs (with or without a point-of-service component), preferred provider organizations (PPOs) and provider-sponsored organizations (PSOs).

An organization that provides dental services through a network of providers to its members in exchange for some form of prepayment. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company.

A dental service plan that allows a member to use either a dental health maintenance organizations (DHMO) network dentist or to seek care from a dentist not in the health maintenance organization's (HMO) network. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company.

An organization that provides dental care to its members through a network of dentists who offer discounted fees to the plan members. For all of your dental questions and/or claim forms, please contact your local Blue Cross Blue Shield company.

A review program that evaluates whether drugs are being used safely, effectively and appropriately.

A computerized record of a patient's clinical, demographic and administrative data. Also known as a computer-based patient record.

A voluntary health insurance program for federal employees, retirees and their dependents and survivors.

Allows members to use pre-tax dollars for certain eligible medical and dependent care expenses. Members fund their FSAs with contributions that come out of their paycheck.

A healthcare system that assumes or shares both the financial risks and the delivery risks associated with providing comprehensive medical services to a voluntarily enrolled population in a particular geographic area, usually in return for a fixed, prepaid fee.

Accounts that employers can establish for employees to reimburse a portion of their eligible family members' out-of-pocket medical expenses, such as deductibles, coinsurance and pharmacy expenses.

Allows members to save money into tax-advantaged accounts. Qualified contributions made to HSAs are tax-deductible, and funds withdrawn to pay for qualified medical expenses are tax-free.

A cost containment program that recovers money for healthcare where primary responsibility does not exist because of another group health plan or contractual exclusions. Includes coordination of benefits, Workers' Compensation, subrogation and no-fault auto insurance.

A type of Health Benefit Plan that allows members to go outside the network for non-emergency care, but may result in a lower level of benefits being paid by the Health Benefit Plan.

Established by the Balanced Budget Act, this program is designed to provide health assistance to uninsured, low-income children either through separate programs or through expanded eligibility under state Medicaid programs.

An evaluation of the medical necessity, appropriateness and cost-effectiveness of healthcare services and treatment plans for a given patient.