Chapter 20 Vocabulary

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Across
  1. 1. Insurance written under a policy that covers a number of people under a single master contract.
  2. 4. An individual entitled to receive benefits from an insurance policy or program or a government entitlement program offering healthcare benefits.
  3. 6. When an individual is covered by two insurance policies, the insurance plan of the policy holder whose birthday comes first in the calendar year becomes the primary insurance.
  4. 7. An umbrella term used for all healthcare plans that provide healthcare in return for preset monthly payments.
  5. 10. An insurance policy designed specifically for the use of one person.
  6. 11. The person responsible for paying the medical bill.
  7. 14. A health benefits program that helps eligible beneficiaries pay the cost of specific healthcare services and supplies
  8. 15. The spouse or child designated by the insured that is covered under a healthcare plan.
  9. 16. An insurance plan funded by an organization having a large enough employee base that it can afford to fund its own insurance program.
  10. 17. A sum of money paid at the time of medical service
  11. 20. A letter or statement from the insurance carrier describing what was paid, denied, or reduced in payment.
  12. 23. A federal and state sponsored health insurance program for the medically indignant.
  13. 25. A patient who refers himself without requesting the referral form of the policy provider.
  14. 27. A policy provision where the policyholder and the insurance company share the cost of covered losses in a specified ratio.
  15. 28. A term sometimes applied to private insurance products that supplement medicare insurance benefits.
  16. 29. A fee schedule designed to provide national uniform payment of medicare benefits.
  17. 30. Insurance against liability imposed on certain employees to pay benefits and furnish care to injured employees and to pay benefits to dependents of employees killed in the course or their employment.
  18. 32. A term used in managed care for an approved referral.
  19. 33. A review of individual cases by a committee to make sure services are medically neccesary.
  20. 35. Traditional health insurance plans that pay for all or a share of the cost of covered services, regardless of which physician or hospital used.
  21. 36. An individual or organization covered by an insurance policy according to the policy terms.
  22. 37. Designed to combat waste, fraud, and the use of medical savings accounts.
  23. 38. A special provision that may be added to a policy to expand or limit the benefits.
  24. 39. A specific amount of money a patient must pay out of pocket before the insurance carrier begins paying.
  25. 41. An insurance term used when a primary care provider wants to send a patient to a specialist.
Down
  1. 2. A person who pays the premium to an insurance company.
  2. 3. A term that describes whether a patients insurance coverage is in effect
  3. 5. Protection in return for periodic premium payments that provides for reimbursements for payments resulting from illness or injury.
  4. 7. Tax deferred bank or savings accounts that are combined with a low premium, high deductible insurance policy.
  5. 8. Entitlement programs or healthcare plans sponsored by the state
  6. 9. A process required by some insurance carriers in which the provider obtains permission to perform certain procedures.
  7. 12. Plans that provide benefits in the form of certain surgical and medical services rendered rather than cash.
  8. 13. A federally sponsored healthcare that covers those over 65, or individuals who are disabled.
  9. 18. an explanation of benefits from Medicare
  10. 19. Limitations on an insurance for which benefits are not payable.
  11. 21. A physician or other healthcare provider who enters into a contract with a specific insurance and agrees to certain regulations and rules.
  12. 22. An organization that contracts with the government to handle and mediate insurance claims
  13. 24. insurance Plans that reimburse the insured for expenses resulting from illness or injury according to a specific fee schedule.
  14. 26. A payment method in which a fixed amount is reimbursed to the provider for patients enrolled for a specific amount of time.
  15. 31. the periodic payment of a specific sum of money, for which the insurer agrees to provide certain benefits.
  16. 34. A government sponsored program wherein authorized dependents of military personnel receive medical care.
  17. 40. A company that assumes the risk of an insurance policy.