Health Insurance Glossary

Balance Billing
Out-of-network providers can charge more for their services. If you see an out-of-network provider, you may be responsible for paying the difference between their price (actual charge) and the maximum amount your insurance plan will pay (allowed amount or allowed benefit).

For example:
  • You see an out-of-network provider for a particular covered service.
  • The provider’s actual charge for that service is $100.
  • But your insurance plan only pays the allowed amount, which is a maximum of $75 for that service.
  • The provider can bill you for the remaining $25—this is balance billing.
[HINT]: To keep your costs lower, it’s best to use in-network providers as much as possible. CareFirst in-network providers have agreed to accept the allowed amount as payment in full and will not balance bill you.
Basic Coverage
Hospital and medical coverage only -- does not include extended medical, major medical, dental and rider coverage. Also includes Medicare Part A and B coverage, exclusive of supplementary coverage.
Behavioral Health Services
See Mental Health Services.
Any service or supply covered by the member's health insurance plan or contract.
Benefit Period
A period of time for which covered services (or benefits) are eligible for payment.
Benefit Reduction Amount
The amount subtracted from allowed benefits under certain cost-savings programs administered by CareFirst.
Benefits Administrator
Individual responsible for handling employee health benefits for the employer. See Group Administrator.
An HMO plan offered by CareFirst BlueChoice, Inc., an independent licensee of the Blue Cross Blue Shield Association.
Brand-name Drug
A prescription drug that has been patented and is only available through one manufacturer.