% out of area members
Percentage of members outside of headquartered city/state
Accolade
Advocacy/Care Navigation platform that some employers use
Aetna
National Medical network and carrier
Annual Medical Spend
Total medical claims spend per year
Anthem
National Medical network and carrier
Anthem JAA Platform
Anthem national network with blue card
Anthem MCS
Anthem’s California only network
Blue Card
BlueCard gives you access to the Anthem network across the nation by uniting Anthem’s network with those of other Blue Cross and Blue Shield licensed companies
Blue Shield
National Medical network and carrier
Carrier
A BUCA carrier (Blue Cross & Blue Shield, UnitedHealth Group, Cigna, Aetna)
Carrier Direct
When an employer is has direct/bundled insurance through a national carrier (i.e. Anthem, Cigna, Aetna, UHC)
CIGNA
National Medical network and carrier
Employee Advocacy/Navigation
A solution that brings all of your benefits into one place and provides high touch concierge service. (i.e. Rightway, Accolade, Quantum, HealthJoy)
Employees on Medical Plan
Number of employees enrolled in medical benefits plan that will be administered
First Health
Regional narrow network and wrap network
Fully Funded
Type of insurance funding for an employer
Funding
The way your medical plan id funded (i.e. Fully Insured or Self-Funded)
Health Management
Population management services insurance companies/TPA offer to help mitigate cost (i.e. Disease Management, Cancer Awareness, Mommies 2B, Case Management)
HealthJoy
Advocacy/Care Navigation platform that some employers use
HealthSmart
Regional narrow network and wrap network
In Area Medical Spend
Total medical spend in geographic location where employer is headquartered
Location
Employer's headquarters
Out of Area Medical Spend
Medical spend outside of geographic location of employers Headquartered city/state
Out of Network
Claims for members that go to a non-network provider (i.e. member has Anthem Network and goes to a physician/Hospital that is not contracted with Anthem)
Pharmacy Benefits Manager
Employers Prescription Drug Benefits Manager
PHCS
Regional narrow network
Primary Medical Network
The employer's primary medical network for their members (i.e. Anthem, Blue Shield, Aetna, Cigna, UHC)
Quantum
Advocacy/Care Navigation platform that some employers use
Reference Based Pricing
A type of arrangement where you don’t have a medical network to maximize savings. All claims are paid at a percentage of Medicare and members can go anywhere for care.
Rightway
Advocacy/Care Navigation platform that some employers use
Self-Funded
Type of insurance funding for an employer
TPA
Third Party Administrator
UHC
United Healthcare - National Medical network and carrier
