Glossary

H

Health Assessment Tool — 

This helps a member gauge potential health risks by answering an online self-assessment. The member receives a report based on the information he/she provides to help him/her determine current health status and learn to manage health care risks.

Health Maintenance Organization (HMO) — 

A managed care plan in which a member receives his/her health care from health care providers participating in a managed care network. A member chooses a Primary Care Physician (PCP) who is responsible for coordinating all aspects of medical care for those members who have selected him/her. These responsibilities include personally providing medical care or referring members to specialty care doctors, other health care professionals and inpatient facilities.

Health Reimbursement Arrangement (HRA) — 

A type of health plan that reimburses employees for qualified medical expenses. These accounts are funded solely by employers to reimburse employees and their dependents for qualified medical expenses, up to a maximum dollar amount for a coverage period. HRAs provide “first-dollar” medical coverage until funds are exhausted. For example, if an employee has a $500 qualifying medical expense, then the HRA covers the full amount, if funds are available in the account. All unused funds are rolled over at the end of the year. HRAs stay with the originating employer and do not follow an employee to new employment.

Health Savings Account (HSA) — 

An account, established on a tax-free basis by an employer, an employee or both, that can be used to pay current and future medical expenses. To be eligible, an individual must not be covered by other health insurance or Medicare. Once established, the account is owned by the individual. Any balance remaining in the account at the end of the year “rolls over” to the next year. An HSA is usually coupled with a high-deductible health plan.

Hematology — 

A specialty focusing on the treatment of diseases of the blood, spleen and lymph glands.

Hepatology — 

A specialty focusing on the liver, gallbladder, biliary tree and pancreas, as well as management of their disorders.

High-Deductible Health Plan (HDHP) — 

A health care plan that features a high deductible applicable to all services (except preventive care) and a limit on annual out-of-pocket expenses. The deductible minimums and out-of-pocket maximums are established pursuant to federal rules. This type of plan is usually coupled with a Health Savings Account.

Home Health Care — 

Eligible health services provided in the patient’s place of residence for the purpose of promoting, maintaining or restoring health or minimizing the effects of illness and disability.

Home Infusion — 

Services provided in the patient’s place of residence where a substance, such as a fluid, nutrient or drug is directly injected into a vein.

Horizon Care@Home — 

Durable Medical Equipment (DME) is medically necessary and appropriate equipment that meets Horizon BCBSNJ eligibility requirements. This equipment may include medical foods [Enteral], and diabetic and other medical supplies, orthotics and prosthetics, and home infusion therapy services. Horizon BCBSNJ and Care Centrix of New Jersey, Inc. conducts reviews of requests for HHS and DME, respectively. CareCentrix of New Jersey, Inc., a subsidiary of CareCentrix Inc., is a New Jersey corporation licensed by the New Jersey Department of Banking and Insurance. Both companies are contracted by Horizon BCBSNJ to administer the Horizon Care@Home Program.

Horizon Young Grins — 

Horizon BCBSNJ’s standalone pediatric dental plan. Horizon Young Grins requires that dental services be obtained from an in-network provider. There is no reimbursement for out-of-network care. These plans are available for members under 19 years of age.

Hospice Care Program — 

A health care program which provides an integrated set of services designed to provide hospice care. A program which supplies family-centered care designed to assist the chronically ill person to be comfortable and to maintain a satisfactory lifestyle through the terminal phases of dying. Hospice services are centrally coordinated through an interdisciplinary team directed by a practitioner.

Hospice Provider — 

A provider that mainly provides palliative and supportive care for terminally ill or terminally injured people under a Hospice Care Program. Horizon BCBSNJ will recognize a Hospice if it carries out its stated purpose under all relevant state and local laws, and it is either : (a) approved for its stated purpose by Medicare; or (b) accredited for its stated purpose by either the Joint Commission or the National Hospice Organization.

Hospital Directory — 

Location and facility name information comes directly from the hospital or facility. We update this information at the hospital's or facility's request.

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