This is a condition under Private Fee-for-Service Plans where some physicians can charge and bill you 15% more than the plan’s payment amount for services.
Base Realignment and Closure Commission (BRAC) site
A military base that has been closed or targeted for closure by the government BRAC.
For dental plans, these are procedures to repair and restore individual teeth due to decay, trauma, impaired function, attrition, abrasion, or erosion. Basic services may include oral surgery, endodontics (root canals), fillings, and periodontics (tissue/bone treatment).
The person who is eligible to receive or is receiving benefits under an insurance certificate. This person is named by the certificate owner, who is usually the person insured
The beneficiary is the person who has health insurance through the Medicare or Medicaid program.
A beneficiary is a person who is eligible for TRICARE benefits. Beneficiaries include Active Duty Family Members (ADFMs) and retired service members and their families. Family members include spouses and unmarried children, adopted children, or stepchildren up to the age of 21 (or 23 if full-time student at approved institutions of higher learning and the sponsor provides more than 50% of the financial support). Other beneficiary categories are listed in the TRICARE Eligibility section of your handbook.
Beneficiary Counseling and Assistance Coordinators (BCACs)
BCACs are persons at Military Treatment Facilities (MTFs) and TRICARE Regional Offices who are available to answer questions, help solve health care-related problems, and assist beneficiaries in obtaining medical care through TRICARE. BCACs were previously known as Health Benefits Advisors (HBAs). To locate a BCAC, visit the TRICARE BCAC/DCAO Directory.
This is the amount that has been paid for a covered person during the calendar year or plan year.
This is a booklet or pamphlet you receive once you enroll in HumanaDental. It contains a general explanation of the benefits. It is also known as Summary Plan Descriptions.
Benefit period refers to time during which you are admitted and treated at a hospital or skilled nursing facility. The benefit period begins the day you go to the facility and ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins.
A benefit plan covers costs associated with certain dental services. In addition to paying premiums for your benefits, you may be responsible for deductibles, coinsurance, and/or maximums.
Benefit plan document
Generic term for a legal document detailing a member's or group's coverage. This document usually is referred to as a Certificate of Coverage, Certificate of Insurance, or Summary Plan Description.
A brief description or outline of your plan’s coverage, your benefit summary includes the amounts or percentage you pay for certain services, the amounts or percentage your plan pays, and the services for which coverage is limited or excluded.
This is the medical — also dental and pharmacy — care for you and your dependents that's covered by your insurance either directly or through reimbursement.
Medicare-approved services provided by an insurance policy are known as benefits. In a health plan, benefits are the coverage amounts for healthcare services you receive, such as doctor’s office visits.
If you use an out-of-network provider, a benefit exclusion is the dollar amount you may be responsible for paying to the doctor or hospital.
This is the highest dollar amount your health plan will pay toward your medical costs over the course of a plan year.
This refers to a detailed summary of all the benefits available in your plan.
This is the amount providers bill for the services they provide.
Any eligible person, physician, doctor's office, hospital, dentist or facility licensed to perform services for our members is a billing provider.
This cosmetic dental procedure whitens teeth using a bleaching solution.
A physician who has graduated from medical school, completed residency, trained under supervision in a specialty, and passed a qualifying exam given by a medical specialty board is considered board certified.