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Explanation of Benefits (EOB): an itemized statement from Blue Cross & Blue Shield or Catalyst that lists charges made and the benefits allowed or denied as the result of a claim. Facility: a hospital or other entity licensed or certified by the appropriate state or federal agency and approved by the Plan and Blue Cross & Blue Shield as a specific type of institution to provide a specific level of care.

Formulary: A specific list of drugs, maintained by Catalyst Rx, that can assist practitioners and pharmacies in selecting clinically appropriate and cost-effective drugs. The formulary represents the clinical judgment of physicians, pharmacists and other experts in the diagnosis and/or treatment of disease and promotion of health.

Generic Drug: a drug that is therapeutically equivalent (identical in strength, concentration, and dosage form) to a brand-name drug and that generally is made available after the expiration of the brand name patent.

Health Care Professional: a physician or other medical practitioner who is licensed to perform

specified health services consistent with state law. include:

  • Physical therapists,

  • Occupational therapists,

  • Speech pathologists,

  • Clinical psychologists (doctoral level),

  • Professional counselors, and

  • Clinical social workers.

For this Plan, health care professionals also

Health Savings Account (HSA): portable, interest-bearing, funded accounts to provide for tax- free savings for medical expenses as provided by Section 1201 of the Medicare Prescription Drug Improvement and Modernization Act of 2003.

High Option for Children: a higher benefit level of coverage for children, available to any enrollee who has a covered dependent child(ren) up to age 18 at an additional cost per month to the enrollee.

HIPAA: the Health Insurance Portability and Accountability Act of 1996.

Home Infusion Therapy: services and supplies required for the administration of home infusion therapy regimen.

Horizon Employee: An employee initially hired on or after January 1, 2006 who has never been a full-time employee of a Mississippi State agency, public school district, community/junior college, public library, or university.

Hospital: an institution which, for compensation from its patients, is primarily engaged in providing diagnostic and therapeutic facilities for the surgical and medical diagnosis, treatment, and care of injured and sick persons by or under the supervision of a staff of physicians who are duly licensed to practice medicine in the state where the institution is located; which continuously


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