Health Care Reform

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Across
  1. 3. these are issued as blanket accident and sickness policies, which are available to undergraduates, graduates, foreign students, and teaching assistants
  2. 5. Issue requires insurance companies to issue a health plan to any applicant
  3. 8. limits portion of premium dollars health insurers may spend on administration, marketing, and profits
  4. 9. addresses lowering administrative costs in health care system by simplifying, standardizing, and progressing towards real-time electronic transactions
  5. 10. abbreviation for Summary of Benefits and Coverage
  6. 11. will be used to determine what individuals may be eligible for premium tax credits
  7. 17. abbreviation for the Department of Health and Human Services, which may designate independent, outside entities to certify and/or audit health plan compliance
  8. 18. Currently, there are only ___ states that require insurance companies to guarantee all products to all residents
  9. 20. abbreviation for the Affordable Care Act
  10. 21. period that must pass before an individual is eligible to be covered for benefits under the terms of the plan
  11. 23. covered at 100% (in-network) for women’s preventative care; brand names if no generics available
  12. 24. tax that will be imposed on the value of health insurance benefits exceeding a certain threshold
  13. 25. a health insurance issuer that offers health insurance coverage in the individual or small group market shall ensure that such coverage includes the _____ package (abbreviation)
  14. 28. the Affordable Care Act expands this to up to 30% of total coverage costs (previously 20%)
  15. 30. limits the extent of issuer gains or losses inside the Exchange.
Down
  1. 1. exchange participants can choose plans in _____ categories
  2. 2. By 1/31/15 the _____ must also provide individuals listed on the report a written statement with the information in the report
  3. 4. health insurers will be required to utilize this so that the community pays the same regardless of health status
  4. 6. four page double-sided document provided to applicants and enrollees with info on details and coverage examples
  5. 7. levels the playing field by assessing insurers with individual and small group enrollment of less‐than average risk and “transferring” those dollars to insurers with enrollment of higher‐than‐average risk
  6. 9. exchange plan tiers are categorized by this value
  7. 12. Protects insurers offering individual coverage from the risk of high cost claims and allows for lower premium levels
  8. 13. this condition is defined as any limitation or exclusion of benefits based on the fact that the condition was present before the effective date of coverage
  9. 14. also known as premium tax credits
  10. 15. Health Care Choice Compacts can be offered starting 1/1/2016 and are for the ________ market only
  11. 16. signed into law on March 23, 2010; Humana implemented the elimination of pre-ex for children (ages 18 and younger) due to this
  12. 19. this Health Care Compact allows two or more states to enter into an agreement where one or more qualified health plans could be offered in the individual markets in all the states that are part of the compact
  13. 21. _________ Compensation - an excepted benefited that is not subject to reform
  14. 22. another name for a waiting period
  15. 26. routine care costs resulting from participation in these approved phase I-IV must now be covered for qualified individuals
  16. 27. There is no reporting requirement for employers with less than _____ employees
  17. 29. Disability _________ - an excepted benefited that is not subject to reform