Commonwealth Care Member Guide - BMC HealthNet Plan

GLOSSARY
COMMONWEALTH CARE–A special state-subsidized health insurance program
managed by the Commonwealth Health Insurance Connector Authority. It is
offered through private health plans, including BMC HealthNet Plan.
COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY (HEALTH CONNECTOR)–
A state organization that determines rules for Commonwealth Care.
CO-PAYMENT–What you pay directly to a provider for a covered service.
Co-payments are usually due at the time you receive the service.
COVERED SERVICES–The healthcare services that BMC HealthNet Plan will pay
for if they are necessary for you. Healthcare services that are not in your
benefit package (depending on your plan type--plan type I, II or III) are not
covered services and will not be paid for by BMC HealthNet Plan.
EVIDENCE OF COVERAGE (EOC)–An important legal document that describes
the relationship between you and BMC HealthNet Plan. It tells you
how the health plan works and lists co-payments you must pay when
you receive covered services.
HARDSHIP WAIVER–If you are having a hard time paying premiums or
co-payments, the Connector may grant you an exception so you
don’t have to pay.
HEALTH PLAN–An organization approved by the Health Connector to work
with certain hospitals, clinics and your doctor so you can receive the
health services covered in your EOC.
HEALTH RISK ASSESSMENT (HRA)–A form you fill out that tells BMC HealthNet
Plan about your health needs. The information you provide is kept private.
HEALTH SERVICES (MEDICAL AND MENTAL HEALTH/SUBSTANCE ABUSE)–Services
obtained from a medical or behavioral health provider.
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