Health Insurance

1. A written agreement between two parties, in which one party (the insurance company) agrees to pay another party (the patient) if certain specified circumstances occur
4. An order from a primary care provider for the patient to see a specialist or to get certain medical services.
5. A set dollar amount that the policyholder must pay before the insurance company starts to pay for services
8. The periodic payment of a specific sum of money to an insurance company, for which the insurer in return agrees to provide certain benefits
9. A designated person who receives funds from an insurance policy
10. An itemized statement of services and costs from a healthcare facility submitted to the health (insurance) plan for payment
11. A set dollar amount that the policyholder must pay for each office visit
12. health care items or services covered under the health insurance plan

2. Poor, needy, impoverished
3. A process that requires the provider to submit documentation to the payer to show the service or treatment is medically needed, and the payer determines if the service or treatment is medically necessary and covered under the insurance plan
6. Payment arrangement where providers are paid a set amount for each enrolled patient per period of time
7. The primary care provider, who is in charge of a patient’s treatment
11. The percentage of costs of a covered healthcare service the policyholder pays after the deductible has been paid