Traditional Medical Coverage:
Amount of medical expenses that must be paid by the member before plan coverage begins. On some plans, the deductible is waived for certain services such as Well-Child and adult office visits. The first two (2) members of an enrolled family to satisfy their individual deductibles in full will satisfy the deductible for the entire family.

Short-Term Medical Coverage:
Amount of medical expenses that must be paid by the member before plan coverage begins. The deductible is waived for accidental injuries. The first two (2) members of an enrolled family to satisfy their individual deductibles in full will satisfy the deductible for the entire family.

Dental Coverage:
Amount of dental expenses that must be paid by the member before plan coverage begins.
Annual Maximum
The maximum amount of benefits available to you during a year.
Annual Out-of-Pocket Maximum

Traditional Medical Coverage:
The maximum amount you will pay for your share of medical expenses during a calendar year (including coinsurance, copayments and deductibles to in- or out-of network providers). After you reach this amount, the plan pays 100% of your medical expenses. The first two (2) members of an enrolled family to satisfy their out-of-pocked maximums will satisfy the requirement for the entire family.

Short-Term Medical Coverage:
The maximum amount you will pay for your share of medical expenses during a calendar year (including coinsurance, co-payments and deductibles to in- or out-of network providers). After you reach this amount, the plan pays 100% of your medical expenses.
Benefit Amount
The amount payable to a beneficiary in the event of the insured's death.
Choice of Dentist
The dental plan offers members the option of going to any dentist they choose. It is to the members benefit to use a participating plan dentists because we have negotiated the amounts that plan members are charged. If members choose a non-participating dentists will they will experience greater out of pocket expenses.
Routine Cleaning
Cleaning of the teeth when there is no gum disease, also known as a prophy or prophylaxis. This includes removal of plaque, tartar and stains from the tooth surface above the gum line. Time to perform this procedure varies with the amount of plaque, tartar or stains present and the length of time since the last cleaning.

Child with fluoride
A teeth-cleaning that includes an application of a fluoride gel or liquid that helps to prevent decay.
Crown

Stainless Steel:
A crown made of stainless steel material is prefabricated and usually used as a temporary measure in baby teeth.

Except Stainless Steel:
A crown is the covering put on a tooth after extensive decay is removed when not enough tooth structure is left to restore it with a filling. Crowns are sometimes used to improve the esthetics of a tooth or teeth (cosmetic) and usually are not covered if there is no decay.
Daily Premium
Is the basis for how the member calculates total premium, based upon the amount of days selected.
Dental Coverage
The policyholder and Blue Cross agree to share the expense of unknown future dental care.
Drug Benefits

Traditional Medical Coverage:
Coverage for medications prescribed by a physician, not sold over-the counter. Most plans provide immediate coverage for generic drugs while brand name drugs are subject to a deductible.

Short-Term Medical Coverage:
Coverage for medications prescribed by a physician, not sold over-the counter. Prescriptions must be filled in a retail pharmacy. Plans provide immediate coverage for generic drugs while brand name drugs are limited to a maximum of $500 per insured.
Emergency Services

Traditional Medical Coverage:
Appropriate treatments for a sudden, serious and unexpected acute illness, injury, psychiatric or medical condition. Benefits are provided for Emergency Room and hospitalization.

Short-Term Medical Coverage:
Appropriate treatments for a sudden, serious and unexpected acute illness, injury, psychiatric or medical condition. Benefits are provided for Emergency Room and hospitalization. Accidental injuries are not subject to the deductible.
Extraction
The process or act of removing a tooth when it is completely erupted and there are no complications.
Filling
Removing decay and replacing one or more surfaces of a tooth structure by using materials such as metal, alloy, resin or porcelain.
Gingivectomy
The removal of gum tissue in one of the 4 sections of the mouth known as the upper right, upper left, lower right or the lower left.
Hospital Inpatient/Outpatient

Traditional Medical Coverage:
Charges for hospital facilities used for both inpatient and outpatient procedures. After you meet the plan's deductible, then you share a percent of these. You save money by choosing a Preferred Participating Hospital.

Short-Term Medical Coverage:
Charges for hospital facilities used for both inpatient and outpatient procedures. After you meet the plan's deductible, then you share a percent of these. You save money by choosing a Preferred Participating Hospital.
HSA Compatible
Compatibility with tax-deferred savings account: Indicate a high level of importance if you are eligible for and would like to participate in a Healthcare Savings Account (HSA).

HSAs are designed to help individuals save for qualified medical expenses on a tax-free basis. An HSA combines a savings account with a High Deductible Health Plan (HDHP). BCC offers the HDHP.

Typically anyone who is not entitled to Medicare and cannot be claimed as a dependent on another person's tax return can qualify for an HSA but must have a qualified High Deductible Health Plan and no other similar health insurance.
Maternity

Traditional Medical Coverage:
Includes pre-natal and post-natal doctor visits, hospital services in connection with pregnancy, physician services for normal delivery, cesarean section and complications of pregnancy as well as routine nursery care for a newborn.

Short-Term Medical Coverage:
Not a benefit under Short-Term Medical coverage
Member Costs
Member is financially responsible for anything above discounted fee in network or anything above the fixed fee for out of network benefits.
Office Visits

Traditional Medical Coverage:
Visits made to a physician's office for one or more of the following services: examination, information gathering, diagnosis and treatment plan.

Short-Term Medical Coverage:
Visits made to a physician's office for one or more of the following services: examination, information gathering, diagnosis and treatment plan.

Dental Coverage:
Visits made to the dental office every time you go.
Oral Exams

Periodic
An examination performed on a returning patient to determine any changes in the patient's dental and medical health condition since the patient's last visit.

Comprehensive
A thorough examination of the oral cavity's hard and soft tissues. This would include the evaluation and recording of a patient's dental and medical history and general health assessment.
Orthodontic Care - Adult
The act of straightening an adult set of teeth.
Orthodontic Care - Child
The act of straightening a child set of teeth.
Orthodontic Care - Retention
The process of using an appliance to stabilize teeth following active orthodontic treatment.
Partial Denture
A removable denture that replaces some missing teeth, top or bottom.
Physician Choice

Traditional Medical Coverage:
Determines whether or not you can go directly to a specialist (PPO plans) or whether referrals must be coordinated by your primary care physician (HMO plans). There are 42,000 doctors and 440 hospitals in our PPO network. You can visit any physician under the PPO plans but you save money by staying within the network.

Short-Term Medical Coverage:
There are 42,000 doctors and 440 hospitals in our PPO network. You can visit any physician under the PPO plans but you save money by staying within the network.
Plan Fit
The degree to which a plan matches your preference profile. The higher your percentage the better your preferences match the plan.
Plan Name
The name of the viewed plan.
Plan Type

Traditional Medical Coverage:
The type of policy, we offer several: Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO) and Health Maintenance Organization (HMO). In general, the wider your choice of doctors and hospitals, the higher your costs will be.

Short-Term Medical Coverage:
The Short-Term Preferred Provider Organization (PPO) is one of the largest networks in the state. You can go to any provider but save money by using network doctors and medical facilities. You decide the length of coverage from a minimum of 30 to a maximum of 185 days.

Term-Life Coverage:
Individual term life insurance.

Dental Coverage:
Participating Provider Product
Pontic
The term used for an artificial tooth on a fixed bridge.
Premium

Monthly Premium:
Traditional Medical Coverage:
The monthly payment you make to Blue Cross of California to maintain your medical coverage, based on your age, location, and plan selection. The more costs you are willing to share when you visit a health care provider, the lower your premium will be.

Term Life Coverage:
The monthly payment you make to Blue Cross of California to maintain your term life coverage, based on the insured's current age and life benefit amount.

Dental Coverage:
The monthly payment you make to Blue Cross of California to maintain your dental coverage.

Total Premium:
After you determine the length of coverage and plan you want, pricing is based on a per member per day rate. The entire amount is due at the time of application.
Premium Details
Calculated based on the insured's current age and Life benefit amount.
Preventive Care - General

Short-Term Medical Coverage:
Access to HealthyCheck screenings for members age 7 to adult.

Traditional Medical Coverage:
Specific benefits for care intended to prevent serious medical conditions through early detection and treatment, including "Well Baby/Child Care" for infants up to age 6. At a minimum, our plans provide benefits for routine mammogram, Pap and PSA tests as well as access to HealthyCheck screenings for members age 7 to adult.
Professional Services

Traditional Medical Coverage:
Include x-rays, lab work, and any inpatient or outpatient services of a surgeon or anesthesiologist. These charges could be required in addition to an office visit or an inpatient or outpatient hospital stay.

Short-Term Medical Coverage:
Include x-rays, lab work, and any inpatient or outpatient services of a surgeon or anesthesiologist. These charges could be required in addition to an office visit or an inpatient or outpatient hospital stay.
Removal of Impacted Tooth

Soft Tissue
Removal of an unerupted tooth in which biting surface of the tooth is covered by soft tissue.

Partial Bony
Removal of an unerupted tooth in which biting surface of the tooth is covered by soft tissue.

Complete Bony
Removal of an unerupted tooth in which most or all of the crown of the tooth is covered by bone.
Root Canal

Anterior
Removal of dead or dying nerve of a tooth located in the front of the mouth. The space created is then filled with an endodontic filling material. This procedure often involves more than one office visit.

Bicuspid
Removal of dead or dying nerve of the tooth with two cusps and filling the space created with an endodontic filling material. This procedure often involves more than one office visit.

Molar
Removal of dead or dying nerve of the tooth used for grinding. These teeth are located in the back of the mouth and having large crowns and broad chewing surfaces. The space created is then filled with an endodontic filling material. This procedure often involves more than one office visit.
Scaling/Root Planning per Quadrant
Indicated for patients with gum disease, and used as a treatment in some stages of the disease and as a pre-surgical step in other stages. It includes removal of plaque, tartar and stains from the crown of the teeth and microbial flora, bacterial toxins, tartar, and other debris on the root surface and in the tooth pocket. Some soft tissue removal occurs.
Sealant
Application of acrylic placed over the biting surface of an unrestored permanent molar tooth to prevent decay.
Short-Term Medical Coverage
Provides a minimum of 30 to a maximum of 185 days of non-renewable medical coverage.
Surgical Extraction
An extraction that requires the dentist to cut the gum and sometimes the bone to remove the tooth. There are always sutures when a surgical extraction is performed.
Term Life Coverage
A type of low-cost, life insurance that only pays benefits if the insured dies during the specified period of time. Unlike whole life insurance, term life insurance does not build cash value.
Tobacco User
Tobacco usage is defined as the use of any type of tobacco or nicotine-containing item including (but not limited to) the following forms: cigarettes, cigars, snuff, chew, patch, gum or lozenges.
Topical Fluoride
An application of a fluoride gel or liquid that helps to prevent decay
Traditional Medical Coverage
As opposed to short-term coverage, traditional medical coverage stays in effect as long as the premium is paid.
X-ray
A diagnostic tool used by dentists to detect tooth decay, abscesses and other dental diseases.

*These definitions are intended to help you determine the plan features that are important to you. A comprehensive description of coverage, benefits and limitations is contained in the Combined Evidence of Coverage and Disclosure Form. For a copy, contact us or your agent.