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81 11/2005
Medicare:
Title XVIII of the Social Security Act which provides payment for medical and health
services to the population aged 65 and over regardless of income, as well as certain
disabled persons and persons with ESRD.
Member:
Any person entitled to receive the benefits for services of a physician or other health
care professionals, facilities or institutions as defined in and pursuant to a
Membership Agreement. Member also includes any individual entitled to receive
benefits pursuant to a Membership Agreement of an Affiliate of BCBSGa.
Member Guide:
A booklet that highlights the basic elements of a member’s health care coverage as
well as special features that may be specific to their plan. Each member receives a
member guide.
Member ID Card:
An identification card issued by PLAN or an Affiliate, which identifies an individual as
a Covered Person. (The Membership Card is for identification purposes only and may
not be used as verification of eligibility.)
Membership Agreement:
A contract between BCBSGa or Affiliate of BCBSGa and an employer, group or
individual to provide, indemnify or administer the delivery of health care benefits
through preferred provider organization.
NCQA:
The National Committee for Quality Assurance is an independent, not-for-profit
entity that works closely with the managed care industry, health care purchasers,
researchers and consumers to develop standards for accreditation to determine
whether a managed care organization is founded and practicing principles of quality
and is continuously working to improve the services it provides. Typically NCQA
auditors use these standards to evaluate managed care organizations with regards to
quality management and improvement, utilization management, credentialing,
member rights and responsibilities, preventive health services, and medical records.