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Health Insurance Basics
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premium : The payment you make to your health insurance company that keeps your coverage active.
copay : A small fixed amount required by a health insurer to be paid by the insured for each outpatient visit or drug prescription.
deductible : A specified dollar amount that must be incurred before the Plan will pay any amount for any benefit during each Benefit Period.
DME : Any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions or illnesses.
EOB : A statement sent by the health plan explaining what medical treatments or services were paid.
TPA: An organization that processes employee benefit claims for a separate entity.
benefit period : A time period of one year, which is either a calendar or other annual period, as shown in the Schedule of Benefits.
date of service : The date the patient received the treatment.
pediatrician : An example of a "Primary Care Physician".
cardiologist : An example of a "Specialist Physician".
out of pocket maximum : The maximum dollar amount that any covered person or family will pay in any benefit period for covered services, treatments, or supplies.
coinsurance : The percentage of claim the member is responsible for after the insurance percentage.
appeal : A patient’s request that the health plan review of change a claim decision.
precertification : Also known as pre-admission review, it is the process of obtaining eligibility and collecting information from the health plan prior to inpatient admissions and selected ambulatory procedures and services.
predetermination : Similar to pre-authorization as it allows services or treatment to be reviewed for medical necessity.
Health Insurance Basics
Across:2. | A specified dollar amount that must be incurred before the Plan will pay any amount for any benefit during each Benefit Period. | 6. | The payment you make to your health insurance company that keeps your coverage active. | 7. | A small fixed amount required by a health insurer to be paid by the insured for each outpatient visit or drug prescription. | 9. | An example of a "Primary Care Physician". | 10. | A statement sent by the health plan explaining what medical treatments or services were paid. | 11. | A patient’s request that the health plan review of change a claim decision. | 13. | Similar to pre-authorization as it allows services or treatment to be reviewed for medical necessity. |
| | Down:1. | The maximum dollar amount that any covered person or family will pay in any benefit period for covered services, treatments, or supplies. | 3. | The percentage of claim the member is responsible for after the insurance percentage. | 4. | A time period of one year, which is either a calendar or other annual period, as shown in the Schedule of Benefits. | 5. | An organization that processes employee benefit claims for a separate entity. | 6. | Also known as pre-admission review, it is the process of obtaining eligibility and collecting information from the health plan prior to inpatient admissions and selected ambulatory procedures and services. | 7. | An example of a "Specialist Physician". | 8. | The date the patient received the treatment. | 12. | Any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions or illnesses. |
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© 2016
PuzzleFast.com, Noncommercial Use Only
Health Insurance Basics
Across:2. | A specified dollar amount that must be incurred before the Plan will pay any amount for any benefit during each Benefit Period. | 6. | The payment you make to your health insurance company that keeps your coverage active. | 7. | A small fixed amount required by a health insurer to be paid by the insured for each outpatient visit or drug prescription. | 9. | An example of a "Primary Care Physician". | 10. | A statement sent by the health plan explaining what medical treatments or services were paid. | 11. | A patient’s request that the health plan review of change a claim decision. | 13. | Similar to pre-authorization as it allows services or treatment to be reviewed for medical necessity. |
| | Down:1. | The maximum dollar amount that any covered person or family will pay in any benefit period for covered services, treatments, or supplies. | 3. | The percentage of claim the member is responsible for after the insurance percentage. | 4. | A time period of one year, which is either a calendar or other annual period, as shown in the Schedule of Benefits. | 5. | An organization that processes employee benefit claims for a separate entity. | 6. | Also known as pre-admission review, it is the process of obtaining eligibility and collecting information from the health plan prior to inpatient admissions and selected ambulatory procedures and services. | 7. | An example of a "Specialist Physician". | 8. | The date the patient received the treatment. | 12. | Any equipment that provides therapeutic benefits to a patient in need because of certain medical conditions or illnesses. |
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© 2016
PuzzleFast.com, Noncommercial Use Only