Health Care Reform

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