85-603: Blue Cross may refer to: Human healthcare [ edit ] Blue Cross Blue Shield Association , a federation of health insurance providers in the United States Canadian Association of Blue Cross Plans , a federation of health insurance providers in Canada International Federation of the Blue Cross , a Christian organization engaged in
170-519: A World War I chemical warfare agent "The Blue Cross" (short story) , a short story by G. K. Chesterton Blue Cross (society) , a Finnish nazi organisation "Blue Cross", a song by P-MODEL from Potpourri See also [ edit ] Cruz Azul , a soccer club in Mexico Modrý kríž , a Christian teetotalers' society founded in Slovakia at the end of the 19th century Topics referred to by
255-407: A combination of regulation and insurance equalization pool . Moral hazard is avoided by mandating that insurance companies provide at least one policy that meets a government set minimum standard level of coverage, and all adult residents are obliged by law to purchase this coverage from an insurance company of their choice. All insurance companies receive funds from the equalization pool to help cover
340-734: A comprehensive public health insurance scheme run by the National Health Authority called the Ayushman Bharat Yojana or a private health insurance scheme providing comprehensive coverage and that is tightly regulated by the Insurance Regulatory and Development Authority of India . There are three major types of insurance programs available in Japan: Employee Health Insurance (健康保険 Kenkō-Hoken), National Health Insurance (国民健康保険 Kokumin-Kenkō-Hoken), and
425-487: A doctor visit, €0.50 for each box of medicine prescribed, and a fee of €16–18 per day for hospital stays and for expensive procedures. An important element of the French insurance system is solidarity: the more ill a person becomes, the less the person pays. This means that for people with serious or chronic illnesses, the insurance system reimburses them 100% of expenses, and waives their co-pay charges. Finally, for fees that
510-409: A form of insurance offered through some health insurance plans. In the U.S., the patient usually pays a copayment and the prescription drug insurance part or all of the balance for drugs covered in the formulary of the plan. Such plans are routinely part of national health insurance programs. For example, in the province of Quebec, Canada, prescription drug insurance is universally required as part of
595-511: A fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all
680-575: A government-owned entity, when it was privatized and listed on the Australian Stock Exchange . Australian health funds can be either 'for profit' including Bupa and nib ; 'mutual' including Australian Unity ; or 'non-profit' including GMHBA , HCF and the HBF Health Insurance . Some, such as Police Health, have membership restricted to particular groups, but the majority have open membership. Membership to most health funds
765-472: A joint marketing agreement with Highmark Blue Shield in Pittsburgh for their separate hospital and medical plans. However, Independence Blue Cross, like most of its sister Blue Cross Blue Shield companies, cover most of their customers under managed care plans such as HMOs and PPOs which provide hospital and medical care in one policy. Blue Cross & Blue Shield of Rhode Island was founded in 1939. The insurer
850-460: A mutual insurance company, with the name again changed, to Blue Cross & Blue Shield of Mississippi, A Mutual Insurance Company. During 2022, BCBS and University of Mississippi Medical Center (UMMC) network entered conflict over who is to blame for an increasing lack of covered care in the state. Media reported that UMMC had paid close to $ 279,000 for digital advertising, commercials, and billboards to attack BCBS, which, in subsequent months, sued
935-673: A need for an appeal, the process typically involves initiating it through the insurance company and then reaching out to the Employer's Plan Fiduciary. If a resolution is still not achieved, the decision can be escalated to the USDOL for review to ensure compliance with ERISA regulations, and, if necessary, legal action can be taken by filing a lawsuit in federal court. Health insurance can be combined with publicly funded health care and medical savings accounts . The individual insured person's obligations may take several forms: Prescription drug plans are
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#17328455795501020-474: A paid internship during their stay. In that case, they'll need to take out the compulsory basic package of Dutch health insurance. Additional insurance is optional, depending on the student's personal needs. Since 1974, New Zealand has had a system of universal no-fault health insurance for personal injuries through the Accident Compensation Corporation (ACC). The ACC scheme covers most of
1105-1005: A partnership with Cambia Health , but cancelled the agreement later that year. Dr. Patrick H. Conway , who had served as CEO from 2017, was scheduled to become CEO of the merged company, replacing retiring Cambia CEO Mark Ganz, but resigned after a DWI arrest in June 2019, putting the merger on hold. Though historically "Blue Cross" was used for hospital coverage while "Blue Shield" was used for medical coverage, today that split only exists for traditional health insurance plans in Pennsylvania . Two independent companies operate in central Pennsylvania, Highmark Blue Shield in Pittsburgh and Capital Blue Cross in Central Pennsylvania. In southeastern Pennsylvania, Independence Blue Cross in Philadelphia has
1190-410: A person's previous medical history, the current state of health, or (generally speaking) their age (but see Lifetime Health Cover below). Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition
1275-584: A policy, or charge anything other than their nationally set and published standard premiums. Therefore, every person buying insurance will pay the same price as everyone else buying the same policy, and every person will get at least the minimum level of coverage. This applies to all people permanently living and working in the Netherlands. International students that move to the Netherlands for study purposes have to take out compulsory Dutch health insurance if they also decide to work (zero-hour contracts included) or do
1360-399: A portion of their income to a not-for-profit health insurance fund, which mutualises the risk of illness, and which reimburses medical expenses at varying rates. Children and spouses of insured people are eligible for benefits, as well. Each fund is free to manage its own budget, and used to reimburse medical expenses at the rate it saw fit, however following a number of reforms in recent years,
1445-489: A routine finance structure, such as a monthly premium or payroll tax , to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity. According to the Health Insurance Association of America , health insurance is defined as "coverage that provides for
1530-509: A stay in ward B2 or C in a Public hospital. For the hospitalization in a Private hospital, or in ward A or B1 in Public hospital, MediShield Life coverage is pegged to B2 or C ward prices and insured is required to pay the remaining bill amount. This remaining bill amount can be paid using MediSave but limits are applied on the MediSave usage. MediShield Life does not cover overseas medical expenses and
1615-578: Is a non-profit health insurance company headquartered in Rochester, New York . It is part of the Blue Cross Blue Shield Association. In 2010, Excellus was Upstate New York 's largest nonprofit health plan. In 2001, Excellus merged with Univera Healthcare , (formerly North AmeriCare ), based in Buffalo, New York . Univera retained its name and is separate from Excellus BCBS. Excellus
1700-667: Is a name used by an association of health insurance plans throughout the United States . Its predecessor was developed by Justin Ford Kimball in 1929, while he was vice president of Baylor University 's health care facilities in Dallas, Texas . The first plan guaranteed teachers 21 days of hospital care for $ 6 a year, and was later extended to other employee groups in Dallas, and then nationally. The American Hospital Association (AHA) adopted
1785-519: Is an independent licensee of the Blue Cross Blue Shield Association, and the largest healthcare provider in the state. It donated $ 1.98 million to The Walton College of Business toward founding its Robert L. Shoptaw Master of Healthcare Business Analytics Program. In August 2022, more than 12,000 members of Arkansas Blue Cross were affected by a ransomware attack on a former affiliate, North Highland Company, LLC. Blue Cross of Idaho and Regence BlueShield Idaho are separate companies and compete throughout
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#17328455795501870-416: Is called Medicare , which provides free universal access to hospital treatment and subsidised out-of-hospital medical treatment. It is funded by a 2% tax levy on all taxpayers, an extra 1% levy on high income earners, as well as general revenue. The private health system is funded by a number of private health insurance organizations. The largest of these is Medibank Private Limited , which was, until 2014,
1955-491: Is covered by the employer and basically covers all risks for commuting to work and at the workplace. The National Health System in Greece covers both out and in-patient treatment. The out-patient treatment is carried out by social administrative structures as following: The in-patient treatment is carried out by: In Greece anyone can cover the hospitalization expenses using a private insurance policy, that can be bought by any of
2040-408: Is designed for people who are age 75 and older. National Health Insurance is organised on a household basis. Once a household has applied, the entire family is covered. Applicants receive a health insurance card, which must be used when receiving treatment at a hospital. There is a required monthly premium, but co-payments are standardized so payers are only expected to cover ten to thirty percent of
2125-489: Is different from Wikidata All article disambiguation pages All disambiguation pages Blue Cross Blue Shield Association Blue Cross Blue Shield Association , also known as BCBS , BCBSA , or The Blues , is a United States –based federation with 33 independent and locally-operated BCBSA companies that provide health insurance in the United States to more than 115 million people as of 2022. It
2210-522: Is distributed to insurance companies for each person they insure under the required policy. However, high-risk individuals get more from the pool, and low-income persons and children under 18 have their insurance paid for entirely. Because of this, insurance companies no longer find insuring high-risk individuals an unappealing proposition, avoiding the potential problem of adverse selection. Insurance companies are not allowed to have co-payments, caps, or deductibles, or deny coverage to any person applying for
2295-426: Is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference. Finally, to counter the rise in health care costs, the government has installed two plans, (in 2004 and 2006), which require insured people to declare a referring doctor in order to be fully reimbursed for specialist visits, and which installed a mandatory co-pay of €1 for
2380-677: Is headquartered in Providence, Rhode Island . BlueCross BlueShield of the U.S. Virgin Islands is administered by BlueCross BlueShield of Puerto Rico. Blue Cross Blue Shield of Wyoming (BCBSWY) is a non-profit founded in 1945. In 2022, BCBSWY penned opposition to the Pharmacy benefit managers act enhancements (Wyoming Senate File 0036). While only some members retain nonprofit status, the ones that do have been criticized for holding excessive amounts of cash or excessive executive compensation. For instance,
2465-488: Is now also available through comparison websites. These comparison sites operate on a commission-basis by agreement with their participating health funds. The Private Health Insurance Ombudsman also operates a free website that allows consumers to search for and compare private health insurers' products, which includes information on price and level of cover. Most aspects of private health insurance in Australia are regulated by
2550-571: The Blue Cross and Blue Shield Association (BCBS). Prior to 1986, organizations administering BCBS were tax exempt under 501(c) (4) as social welfare plans. The Tax Reform Act of 1986 revoked the exemption, however, because the plans sold commercial-type insurance. They became 501(m) organizations, subject to federal taxation, but entitled to "special tax benefits" under IRC 833. In 1994, BCBS changed to allow its licensees to be for-profit corporations. During 2010, Health Care Service Corporation ,
2635-466: The Chicago Loop area of Chicago, Illinois. Single-state members include the following organizations. Blue Cross Blue Shield of Arizona (BCBSAZ) is a non-profit healthcare organization founded in 1939. BCBSAZ partners with non-profit "Discovery Triangle Development Corporation" to launch a Farm Express mobile market (formerly Fresh Express). Founded in 1948, Arkansas Blue Cross Blue Shield (ABCBS)
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2720-561: The Federal Employees Health Benefits Program (FEHB) for U.S. federal government employees and retirees, and has been part of FEHB since FEHB's inception in 1960. FEP enrolls over half of the federal workforce, with over 5 million members, making it the largest insurer of federal employees and the largest single health plan group in the world. The association is headquartered in the Michigan Plaza complex in
2805-604: The Private Health Insurance Act 2007 . Complaints and reporting of the private health industry is carried out by an independent government agency, the Private Health Insurance Ombudsman . The ombudsman publishes an annual report that outlines the number and nature of complaints per health fund compared to their market share The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of
2890-564: The Royal Canadian Mounted Police , the armed forces, and Members of Parliament). Consequently, each province administers its own health insurance program. The federal government influences health insurance by virtue of its fiscal powers – it transfers cash and tax points to the provinces to help cover the costs of the universal health insurance programs. Under the Canada Health Act , the federal government mandates and enforces
2975-591: The Blue Cross symbol in 1939 as the emblem for plans meeting certain standards. In 1960, the AHA commission was superseded by the Blue Cross Association. Blue Cross severed its ties with the AHA in 1972. Blue Shield was developed by employers in lumber and mining camps of the Pacific Northwest to provide medical care by paying monthly fees to medical service bureaus composed of groups of physicians. In 1939,
3060-546: The CEO of BCBS Michigan, Daniel Loepp, earned over 19 million USD in 2018, more than the CEO of Ford or Fiat Chrysler during the same year. In 2014, BC/BS of Illinois ( Health Care Service Corporation ) was sued over its nonprofit status. The lawsuit was dismissed, with prejudice , and the dismissal ruling was upheld on appeal. Similar suits occurred with similar results in other states such as Oregon. Conversions into for-profit corporations typically results in distribution of some of
3145-639: The Health Care for the Aged Law of 1982. It allowed many health insurance systems to offer financial assistance to elderly people. There is a medical coverage fee. To be eligible, those insured must be either: older than 70, or older than 65 with a recognized disability. The Late-stage Elderly Medical System includes preventive and standard medical care. Due to Japan's aging population , the Late-stage Elderly Medical System represents one third of
3230-474: The Late-stage Elderly Medical System (後期高齢医療制度 Kouki-Kourei-Iryouseido). Although private health insurance is available, all Japanese citizens, permanent residents, and non-Japanese with a visa lasting one year or longer are required to be enrolled in either National Health Insurance or Employee Health Insurance. National Health Insurance is designed for those who are not eligible for any employment-based health insurance program. The Late-stage Elderly Medical System
3315-627: The Prevention of Cruelty to Animals Buildings [ edit ] Blue Cross Blue Shield Tower , a building located in Chicago, Illinois, home to the headquarters of Health Care Service Corporation Blue Cross Centre , an office building located in the central business district of Moncton, New Brunswick Blue Cross Arena , a multi-purpose indoor arena, located in Rochester, New York Other uses [ edit ] Blue Cross (chemical warfare) ,
3400-407: The U.S. (nearly 16% of GDP). Germans are offered three kinds of social security insurance dealing with the physical status of a person and which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance. Long-term care insurance ( Gesetzliche Pflegeversicherung ) emerged in 1994 and is mandatory. Accident insurance (gesetzliche Unfallversicherung)
3485-495: The United Kingdom, Germany, Canada and the U.S. Its 2007 study found that, although the U.S. system is the most expensive, it consistently under-performs compared to the other countries. One difference between the U.S. and the other countries in the study is that the U.S. is the only country without universal health insurance coverage. The Commonwealth Fund completed its thirteenth annual health policy survey in 2010. A study of
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3570-455: The United States (5 to 6 days). Part of the difference is that the chief consideration for hospital reimbursement is the number of hospital days as opposed to procedures or diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in
3655-556: The United States District Court, Western District of Louisiana ruled that "Because Salim showed that PBT was a nationally accepted standard of care for advanced head and neck cancer in 2018, BCBSLA abused its discretion in finding Salim's PBT treatment was not medically necessary." A Propublica investigation found that Blue Cross and Blue Shield of Louisiana used guidelines from an outside company called AIM Specialty Health to reject appeals for denial, and that this practice
3740-475: The United States and in more than 170 other countries, which it then licenses to the affiliated companies for specific, exclusive geographic service areas. It has affiliated plans in all 50 states, Washington, D.C., and Puerto Rico , and licensees offering plans in several foreign countries; it also participates in the nationwide health insurance program for employees of the United States federal government . BCBSA manages communications between its members and
3825-517: The assets into a charitable foundation . When Blue Cross of California was converted, it initially had no distribution, but subsequently The California Endowment and California Health Care Foundation were endowed with $ 3.2 billion. Proceeds ranged from $ 3.2 billion (California) to $ 1.5 million (Nevada). An exceptional case occurred in the Empire Blue Cross conversion, where the proceeds went to fund wage increases for union workers. In 2022,
3910-417: The association and traditionally of each other, offering insurance plans within defined regions under one or both of the association's brands. Blue Cross Blue Shield insurers offer some form of health insurance coverage in every U.S. state . They also act as administrators of Medicare in many states or regions of the U.S. The Blue Cross Blue Shield Federal Employee Program (FEP) is a nationwide option under
3995-689: The case of private insurance. It can also be mandatory for all citizens in the case of national plans. The type and amount of health care costs that will be covered by the health insurance provider are specified in writing, in a member contract or "Evidence of Coverage" booklet for private insurance, or in a national health policy for public insurance. There are two types of health insurance – tax payer-funded and private-funded. A private-funded insurance plan example includes an employer-sponsored self-funded ERISA (Employee Retirement Income Security Act of 1974) plan. Typically, these companies promote themselves as having ties to major insurance providers. However, in
4080-530: The context of an ERISA plan, these insurance companies do not actively participate in insurance practices; instead, they handle administrative tasks. Consequently, ERISA plans are exempt from state regulations and fall under federal jurisdiction, overseen by the US Department of Labor (USDOL). Specific details about benefits or coverage can be found in the Summary Plan Description (SPD). Should there be
4165-439: The cost of this government-mandated coverage. This pool is run by a regulator which collects salary-based contributions from employers, which make up about 50% of all health care funding, and funding from the government to cover people who cannot afford health care, which makes up an additional 5%. The remaining 45% of health care funding comes from insurance premiums paid by the public, for which companies compete on price, though
4250-677: The cost, depending on age. If out-of-pocket costs exceed pre-determined limits, payers may apply for a rebate from the National Health Insurance program. Employee Health Insurance covers diseases, injuries, and death regardless of whether an incident occurred at a workplace. Employee Health Insurance covers a maximum of 180 days of medical care per year for work-related diseases or injuries and 180 days per year for other diseases or injuries. Employers and employees must contribute evenly to be covered by Employee Health Insurance. The Late-stage Elderly Medical System began in 1983 following
4335-661: The costs of related to treatment of injuries acquired in New Zealand (including overseas visitors) regardless of how the injury occurred, and also covers lost income (at 80 percent of the employee's pre-injury income) and costs related to long-term rehabilitation, such as home and vehicle modifications for those seriously injured. Funding from the scheme comes from a combination of levies on employers' payroll (for work injuries), levies on an employee's taxable income (for non-work injuries to salary earners), levies on vehicle licensing fees and petrol (for motor vehicle accidents), and funds from
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#17328455795504420-484: The country's total healthcare cost. When retiring employees shift from Employee Health Insurance to the Late-stage Elderly Medical System, the national cost of health insurance is expected to increase since individual healthcare costs tend to increase with age. In 2006, a new system of health insurance came into force in the Netherlands. This new system avoids the two pitfalls of adverse selection and moral hazard associated with traditional forms of health insurance by using
4505-401: The different health care funds (there are five: General, Independent, Agricultural, Student, Public Servants) now all reimburse at the same rate. Secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor). This regime, unlike the worker-financed ones,
4590-610: The first official Blue Shield plan was founded in California. In 1948, the symbol was informally adopted by nine plans called the Associated Medical Care Plan, and was later renamed the National Association of Blue Shield Plans. In the 1960s, the U.S. government chose to partner with Blue Cross and Blue Shield companies to administer Medicare . In 1982, Blue Shield merged with The Blue Cross Association to form
4675-654: The fund's members, causing some to drop their membership, which would lead to further rises in premiums, and a vicious cycle of higher premiums-leaving members would ensue. The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include: As per the Constitution of Canada , health care is mainly a provincial government responsibility in Canada (the main exceptions being federal government responsibility for services provided to aboriginal peoples covered by treaties,
4760-474: The general taxation pool (for non-work injuries to children, senior citizens, unemployed people, overseas visitors, etc.) Rwanda is one of a handful of low income countries that has implemented community-based health insurance schemes in order to reduce the financial barriers that prevent poor people from seeking and receiving needed health services. This scheme has helped reach 90% of the country's population with health care coverage. Singaporeans have one of
4845-614: The government account for nearly 30 percent of total health care spending. In 2005, the Supreme Court of Canada ruled, in Chaoulli v. Quebec , that the province's prohibition on private insurance for health care already insured by the provincial plan violated the Quebec Charter of Rights and Freedoms, and in particular, the sections dealing with the right to life and security , if there were unacceptably long wait times for treatment, as
4930-462: The group of 34 companies that make up the BCBS Association settled an antitrust investigation by allowing competition among member companies under non-Blue names while retaining regional exclusivity for regional licenses. In 2018 Robert Salim was diagnosed with stage 4 throat cancer, however the proton therapy ordered by his doctor was denied by Blue Cross Blue Shield. Salim sued. In July 2022
5015-405: The hospital for defamation. Blue Cross Blue Shield of Nebraska was founded in 1939. On July 1, 2018, BCBS Nebraska formed GoodLife Partners Inc., a mutual holding company, to conduct its noninsurance businesses. The company retained the Blue Cross brand, converting from mutual ownership to a stock company wholly owned by GoodLife. Excellus BlueCross BlueShield ( Excellus BCBS , or Excellus )
5100-607: The individual's income, private health insurance contributions are based on the individual's age and health condition. Reimbursement is on a fee-for-service basis, but the number of physicians allowed to accept Statutory Health Insurance in a given locale is regulated by the government and professional societies. Co-payments were introduced in the 1980s in an attempt to prevent over utilization. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in
5185-456: The local or multinational insurance companies that operate in the region (e.g. Metlife, Interamerican, Aetna, IMG). In India, provision of healthcare services and their efficiency varies state-wise. Public health services are prominent in most of the regions with the national government playing an important role in funding, framing and implementing policies and operating public health insurances. The vast majority of Indians are covered by either
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#17328455795505270-469: The longest life expectancy at birth in the world. During this long life, encountering uncertain situations requiring hospitalization are inevitable. Health insurance or medical insurance cover high healthcare costs during hospitalization. Health insurance for Singapore Citizens and Permanent Residents MediShield Life , is a universal health insurance covering all Singapore Citizens and Permanent Residents. MediShield Life covers hospitalization costs for
5355-409: The majority of funds provide the same level of reimbursement and benefits. The government has two responsibilities in this system. Today, this system is more or less intact. All citizens and legal foreign residents of France are covered by one of these mandatory programs, which continue to be funded by worker participation. However, since 1945, a number of major changes have been introduced. Firstly,
5440-588: The mandatory system does not cover, there is a large range of private complementary insurance plans available. The market for these programs is very competitive, and often subsidised by the employer, which means that premiums are usually modest. 85% of French people benefit from complementary private health insurance. Germany has the world's oldest national social health insurance system, with origins dating back to Otto von Bismarck 's Sickness Insurance Law of 1883. Beginning with 10% of blue-collar workers in 1885, mandatory insurance has expanded; in 2009, insurance
5525-441: The operating policies required to be a licensee of the trademarks. This permits each BCBSA company to offer nationwide insurance coverage through its BlueCard provider network and claims reimbursement program even though it operates only in its designated service area. Blue Cross and Blue Shield developed separately, with Blue Cross providing coverage for hospital services and Blue Shield covering physicians' services. Blue Cross
5610-602: The parent company of BCBS in Texas, Oklahoma, New Mexico, Montana and Illinois, nearly doubled its income to $ 1.09 billion in 2010, and began four years of billion-dollar profits. In the final spending bill for FY 2015 after much lobbying since 2010, nonprofit Blue Cross and Blue Shield plans continue to have special tax breaks that were understood to be threatened by the Affordable Care Act of 2010. Blue Cross and Blue Shield insurance companies are licensees , independent of
5695-459: The payments of benefits as a result of sickness or injury. It includes insurance for losses from accident, medical expense, disability, or accidental death and dismemberment". A health insurance policy is a insurance contract between an insurance provider (e.g. an insurance company or a government) and an individual or his/her sponsor (that is an employer or a community organization). The contract can be renewable (annually, monthly) or lifelong in
5780-676: The prevention, treatment and aftercare of problems related to alcohol and other drugs Charities for animal healthcare and welfare [ edit ] Blue Cross (animal charity) , an animal charity in the United Kingdom Irish Blue Cross , an animal charity in Ireland Blue Cross of India , an animal charity in India Blue Cross Zimbabwe, an organization associated with the Zimbabwe Society for
5865-453: The provider's usual fee. The provider may also have a separate contract with the insurer to accept what amounts to a discounted rate or capitation to the provider's standard charges. It generally costs the patient less to use an in-network provider. The Commonwealth Fund, in its annual survey, "Mirror, Mirror on the Wall", compares the performance of the health care systems in Australia, New Zealand,
5950-499: The public health insurance plan, but may be purchased and administered either through private or group plans, or through the public plan. Some, if not most, health care providers in the United States will agree to bill the insurance company if patients are willing to sign an agreement that they will be responsible for the amount that the insurance company does not pay. The insurance company pays out of network providers according to "reasonable and customary" charges, which may be less than
6035-658: The public health plans do not cover (for example, semi-private or private rooms in hospitals and prescription drug plans). Four provinces allow insurance for services also mandated by the Canada Health Act, but in practice, there is no market for it. All Canadians are free to use private insurance for elective medical services such as laser vision correction surgery, cosmetic surgery, and other non-basic medical procedures. Some 65% of Canadians have some form of supplementary private health insurance; many of them receive it through their employers. Private-sector services not paid for by
6120-429: The public provincial health insurance systems in Canada are frequently referred to as Medicare . This public insurance is tax-funded out of general government revenues, although British Columbia and Ontario levy a mandatory premium with flat rates for individuals and families to generate additional revenues – in essence, a surtax. Private health insurance is allowed, but in six provincial governments only for services that
6205-435: The requirement that all people have free access to what are termed "medically necessary services," defined primarily as care delivered by physicians or in hospitals, and the nursing component of long-term residential care. If provinces allow doctors or institutions to charge patients for medically necessary services, the federal government reduces its payments to the provinces by the amount of the prohibited charges. Collectively,
6290-417: The same term [REDACTED] This disambiguation page lists articles associated with the title Blue Cross . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=Blue_Cross&oldid=1109568736 " Category : Disambiguation pages Hidden categories: Short description
6375-507: The signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. Funds have the discretion to reduce or remove such waiting periods in individual cases. They are also free not to impose them, to begin with, but this would place such
6460-577: The state. Blue Cross and Blue Shield of Kansas (BCBSKS) was founded in 1942 by Sam Bartham, later becoming an independent licensee of the Blue Cross Blue Shield Association. Blue Cross Blue Shield of Louisiana is a tax-paying non-profit that was founded in 1934 in New Orleans . An independent licensee of the BCBSA, it is a privately held mutual company without shareholders, which is wholly owned by its policyholders. Blue Cross Blue Shield of Minnesota (BCBSMN)
6545-480: The survey "found significant differences in access, cost burdens, and problems with health insurance that are associated with insurance design". Of the countries surveyed, the results indicated that people in the United States had more out-of-pocket expenses, more disputes with insurance companies than other countries, and more insurance payments denied; paperwork was also higher although Germany had similarly high levels of paperwork. The Australian public health system
6630-414: The variation between the various competing insurers is only about 5%. However, insurance companies are free to sell additional policies to provide coverage beyond the national minimum. These policies do not receive funding from the equalization pool but cover additional treatments, such as dental procedures and physiotherapy, which are not paid for by the mandatory policy. Funding from the equalization pool
6715-1164: Was alleged in this case. The ruling has not changed the overall pattern of health insurance across Canada, but has spurred on attempts to tackle the core issues of supply and demand and the impact of wait times. In 2020 in Cyprus introduced the General Healthcare System (GHS, also known as GESY) which is an independent insurance fund through which clinics, private doctors, pharmacists, laboratories, microbiological laboratories, and physiotherapists will be paid so that they can offer medical care to permanent residents of Cyprus who will be paying contributions to this fund. In addition to GESY, more than 12 local and international insurance companies (e.g. Bupa , Aetna, Cigna , Metlife ) provide individual and group medical insurance plans. The plans are divided into two main categories plans providing coverage from inpatient expenses (i.e. hospitalization, operations) and plans covering inpatient and outpatient expenses (such as doctor visits, medications, physio-therapies). The national system of health insurance
6800-591: Was formed in 1982 from the merger of its two namesake organizations: Blue Cross was founded in 1929 and became the Blue Cross Association in 1960, and Blue Shield emerged in 1939 and the Blue Shield Association was created in 1948. Its headquarters are at the Aon Center at 200 E. Randolph Street in Chicago , Illinois . BCBSA claims to control access to the Blue Cross and Blue Shield trademarks and names across
6885-404: Was founded in 1933, with 3,500 employees reported in 2022. Blue Cross Blue Shield of Mississippi (BCBSMS) was formed as a privately held company in 1954. In 1948, it was converted to a non-profit. In 1973, its name was changed from Mississippi Hospital and Medical Service to Blue Cross & Blue Shield of Mississippi, Inc., which, in 1996, was converted from a non-profit membership corporation to
6970-556: Was instituted in 1945, just after the end of the Second World War. It was a compromise between Gaullist and Communist representatives in the French parliament. The Conservative Gaullists were opposed to a state-run healthcare system, while the Communists were supportive of a complete nationalisation of health care along a British Beveridge model. The resulting programme is profession-based: all people working are required to pay
7055-504: Was made mandatory on all citizens, with private health insurance for the self-employed or above an income threshold. As of 2016, 85% of the population is covered by the compulsory Statutory Health Insurance (SHI) ( Gesetzliche Krankenversicherung or GKV ), with the remainder covered by private insurance ( Private Krankenversicherung or PKV ). Germany's health care system was 77% government-funded and 23% privately funded as of 2004. While public health insurance contributions are based on
7140-808: Was the target of a cyberattack in 2015, in which 10.5 million records were hacked, and cost the company 17.5 million dollars. The company's Blue Cross Blue Shield subsidiaries have been known as: By September 2010, BCBS licensee Blue Cross and Blue Shield of North Carolina announced that it would refund $ 156 million to their policyholders following documented charges: they had been sued and fined for denying due medical treatments to their customers and for underpaying doctors. As of 2019 they were overseeing well over half of all payments for medical services in their state. BCBSNC invests in chronic and underlying condition research, telehealth and artificial intelligence (AI) for digital healthcare . In 2019, Blue Cross and Blue Shield of North Carolina agreed to enter into
7225-491: Was widespread. Health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses . As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop
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